Demo Form

To,
The Registrar,
Indian Institute of Public Health Gandhinagar
Opp. Air Force Headquarters,
Near Lekawada Bus Stand,
Gandhinagar, Gujarat – 382 042

Sub: Application for the Post (Position Code) of:

A) Personal information:

Photograph

First Name:

Middle Name:

Surname:

Gender:

Nationality:

Ex-servicemen:

Yes No

Physically Challanged:

Yes No

Category:

General SC ST OBC

Date of Birth:

(dd/mm/yyyy)

E-mail:

Marital Status:

Married Unmarried Separated Others

Contact Numbers:

Primary number

Secondary number

Current Address:

State & Pincode

Permanent Address:

Same as current:

State & Pincode

B) Educational Qualification:

Sr. #	Examination Passed	Main Subject	Percentage Obtained	University / Institute	Year of Passing	Documents
1	S.S.C
2	H.S.C
3	GRADUATION
4	MASTER
5	OTHER
5A
5B
5C

Computer Proficiency:

Additional information:

C) Experiance Details (Start with recent experiance.)

Sr. #	Joining Date (dd/mm/yyyy)	Leaving Date (dd/mm/yyyy)	Designation	Organization Name	Your Job Profile
1
2
3
4
5

* Total Experience in Months required for this job.

D) Your monthly current salary break-up (Please enclose salary slip of last 3 months)

Salary components	Income (Rs.)	Deduction (Rs.)



Total
Net Salary

Upload Salary slips:

E) Reference (Minimum 2)

Reference #1:

Name

Relationship

Contact number

Email:

Reference #2:

Name

Relationship

Contact number

Email:

I hereby declare that I have carefully read and understood all the instructions attached to the advertisement available on IIPHG website www.iiphg.edu.in and that all the entries in this form as well as the attachments are true to the best of my knowledge and belief.

Demo Form

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