DME ASSAM
       GOVERNMENT OF ASSAM COMBINED APPLICATION FORM FOR FILLING UP POSTS UNDER DIRECTORATE OF MEDICAL EDUCATION, DIRECTORATE OF HEALTH SERVICES, DIRECTORATE OF HEALTH SERVICES (F/W) ASSAM

 
CANDIDATE'S PERSONAL INFORMATION
Full Name of the Candidate ( As per Aadhaar Card/ Pan Card/ Passport ) :
Candidate's Father's Name :
Candidate's Mother's Name :
Candidate's Spouse Name :
Candidate's Date of Birth (DD/MM/YYYY) :
Gender : Male   Female   Transgender
Address for Correspondence :
 
 
City
District:
State :
Pin Code :
Permanent Address :  Same As Above
 
 
City
District:
State :
Pin Code :
Mobile No. of the Candidate :     
Alternative Contact No. Telephone / Mobile. :
E-mail Address of the Candidate :
Nationality of the Candidate :
Physical identification Marks: : (a)
(b)
RESERVATION
Category of the Candidate :
GENERAL SC    ST(P)    ST(H)    OBC/MOBC   
Do you belong to Physically challenged/Divyang? : Yes     No
Whether Candidate is Permanent Resident of Assam ? : YES      NO  
GRADE - III POSTS
Do you want to apply for Non - Technical Posts Yes  No 
EMPLOYMENT EXCHANGE REGISTRATION NO. OF ASSAM
Employment Exchange Registration No. of Assam :  
EDUCATION QUALIFICATION
UPLOAD PHOTOGRAPH & SIGNATURE
Instruction For Photograph:
If your Photo is not Identifiable then your Application Form will be Rejected.
=> .JPG Format is required .
=> Size of photograph must be less than 50 kb.
=> Height of photograph must be between 250 pixel and 320 pixel.
=> width of photograph must be between 150 pixel and 220 pixel.
Instruction For Signature:
If your Sign is not Identifiable then your Application Form will be Rejected.
=> .JPG Format is required .
=> Size of signature must be less than 30 kb.
=> Height of signature must be between 100 pixel and 180 pixel.
=> width of signature must be between 150 pixel and 220 pixel.
LOGIN DETAILS OF THE CANDIDATE
       Password :
( minimum 8 character and maximum 12 )
      Confirm Password :
(* Preserve the Password carefully for further login.)
DECLARATION OF THE CANDIDATE
1. I am a candidate for the post of and the facts stated above are true to the best of my knowledge and belief. In case any statement made by me in this application form is found to be false or not fulfilling the eligibility criteria laid down in the Advertisement at any stage, my candidature for the post will stand cancelled and I will be liable to any action Govt. of Assam may deem fit and proper.
IMPORTANT NOTE
***** Please recheck the Application form before Final Submit *****
I have checked all entries in the Application Form filled by me and the Application form is correct. I know that it cannot be changed after submitting the Application Form. The entries made are correct as per my documents.



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