SIMS- Shimoga
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SHIMOGA INSTITUTE OF MEDICAL SCIENCES [SIMS], SHIMOGA
Application for the post of COVID / Non covid Medical Staff on Contract/Temporary/Part-Time Basis
Application for Post
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Physician
Pulmonologist
Anesthetist
Gynecologist
Qualification
MBBS
MBBS,MS
MBBS,MD
KMC Regn. # & Date
UG Regn # & Date
Required
PG Regn # & Date
Personl Information
Candidate Name
Name is missing
Only Alphabest in Name (No special Characters allowed)
Date of Birth
Category
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General Merit
Scheduled Caste[SC]
Scheduled Tribe[ST]
Category-1
Category-2A
Category-2B
Category-3A
Category-3B
Reservation
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U-Unreserved
W-Women
R-Rural
Ex-MP-Ex Military
KM-Kannada Medium
PHC-Physically Challenged
DP-Displaced Person
HYK-Hyderabad Karnataka
Address
City
State
State
Karnataka
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chhattisgarh
Goa
Gujarat
Haryana
Himachal Pradesh
Jharkhand
Kerala
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Punjab
Rajasthan
Sikkim
Tamil Nadu
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
Telangana
Andaman and Nicobar
Chandigarh
Dadra and Nagar Haveli
Daman and Diu
Jammu
Laddakh
Lakshadweep
New Delhi
Puducherry
Mobile Number
Mobile Number missing
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Email Address
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Required
Academic Qualification Details
Qualification
Marks/Grade
Max.Marks
Marks Secured
Name of College
Year of Passing
No. of Attempts
MBBS
Phase-I
Phase-II
Phase-III
Phase-VI
M.D./M.S.
Working Experience
(Enclose relevant docuemnt)
Name of Hospital/Institute
Designation
From
To
Years
Months
Days
Invalid date format.
Invalid date format.
Photo
Photo Copies of Documents Attached
Yes / No
SSLC Marks Card
No
Yes
MBBS Marks Card / Certificate
No
Yes
MD/MS Marks Card / Certificate
No
Yes
KMC Registration Certificate
No
Yes
Experience Certificate
No
Yes
Category/Caste Certificate
No
Yes
I Hereby solemnly affirm that the statement made, information furnished and documents submitted by me along with this declaration are true & correct. to the best of my knowledge. I also declare that during my previuous appointment I have not been subjected to the Departmental Enquiry and punished or convicted under any criminal case. If any information furnished therein is found to be fraudulent, incorrect or untrue, I am liable for prosecution and cancellation of my appointment. I also agree to abide by the Rules and Regulations prescribed by the Government, and bye-laws of SIMS, Shimoga.
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