All India Institute Of Medical Sciences, Bathinda


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ALL INDIA INSTITUTE OF MEDICAL SCIENCES, BATHINDA
JODHPUR ROMANA, MANDI DABWALI ROAD, BATHINDA, PUNJAB- 151001 ਅਖਿਲ ਭਾਰਤੀ ਆਯੁ ਰਖਿਖਿਆਨ ਸੰਸਥਾਨ, ਬਖ ੰ ਡਾ | अखिल भारतीय आयुर्विज्ञान संस्थान, बर् ं डा
RECRUITMENT CELL

Application Form for Faculty Post for AIIMS, Bathinda on Deputation Basis

Application for the post of ..................................................................................................................in the Department of..................................................................on Deputation basis at AIIMS, Bathinda

1. Name and address in BLOCK letters

.................................................. .................................................. .................................................. ..................................................

Affix here recent
pa..s.sp..o.rt.s.i.z.e. p.h.o.t.o.g.raph
.......... ......

2. Father’s Name

.......... ......

3. Date of Birth (in Christian era)
4. Date of retirement under Central/State Government Rules
5. Educational Qualification i)

ii)

iii)

iv)

6. Whether educational and other qualifications required for the post are satisfied (if any qualification has been treated as equivalent to the one prescribed in the rules, state theauthority for the same).

Essential

Required

Possessed by the Applicant

Desirable
7. Please state clearly whether in the light of entries madeby you above, you meet the requirements of the post
AIIMS Bathinda

Page 1 of 4

8.

Details of employments (in chronological order) enclose a separate sheet, duly authenticated by your signature if the space below is insufficient.

S.

No

Name of the

Office/Institute/Organization)

Post Held

Duration of Experience

From

To

Total Duration of Experience
Year(s), Month(s), day(s)

Pay-band and Grade pay (Scale of Pay if in prerevised scale
of pay)

Nature of Duties

1.

2. 3.

4.
5.
Total work experiencein required Grade Pay:

……..…….……..………..Year(s)………………..…………….. Month(s) .................... Day(s)

AIIMS Bathinda

Page 2 of 4

9. Nature of present employment (i.e.ad-hoc or temporary or quasi-permanent or permanent)
10. In case the present employment is held on deputation/contract basis, please state: (a) the date of initial appointment (b) period of appointment on deputation/contract (c) name of the parent office/organization to which you belong
11. Additional details about present employment please state whether working under: (a)Central Government (b)State Government (c)Autonomous Organization (d)Government undertaking (e)University
12. Are you in revised scale of pay? If yes, give the date from which the revision took place and also indicate the pre-revised scale.
13. Total emoluments per month now drawn.

14. Additional information, if any which you would like to mention in support of your suitability for the post. Enclose a separate sheet, if the space is Insufficient.

15. Whether belongs to SC/ST/OBC (if yes, please specify)

16. Contact 1) Office Nos. 2) Residence

3) Mobile

4) E-mail address

17.

If selected, specify the minimum required joining time

Signature of the Candidate

Candidate’s Address:

Date: Countersigned:

[Employer/Authorized Officer]

AIIMS Bathinda

Page 3 of 4

ALL INDIA INSTITUTE OF MEDICAL SCIENCES, BATHINDA BRIEF OF THE CANDIDATE

Name of the Candidate: Applied for the Post of:

Applied in the Department:

Year

Applied under Category:

(UR/OBC/SC/ST/EWS)

Date of Birth

Month

Day

Paste recent passport size photograph
here.
Age of candidate as on last date of submission of online application

Qualification Degree MBBS M.D.
D.M./M.Ch D.N.B. PGDNB
Any other
Post/Level/ Designation

Year of Passing

Qualification No. of attempts

Duration

From

To

Experience
Name of the Organization/Institution

Name of the Institution Duration (YYMMDD)

National/ International
National International
Total
Chapter in Books : Awards/
Recognitions:

Indexed

NonIndexed

Any other information: Notice period required for joining:

Paper Published Accepted of publication

Presented at Conferences

Date:…………………… AIIMS Bathinda

Signature of Candidate Page 4 of 4

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All India Institute Of Medical Sciences, Bathinda