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Job Application

Indian Institute of Public Health Gandhinagar

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 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.