ONLINE APPLICATION FORM
(Strategic Alliance Management Services Pvt Ltd)
 

(This form comprises a key element of our screening process and the quality of your response is likely to have a significant impact on your further consideration)

Personal

Name:

Father's Name:

Addresses:

Residence Address
Pin Code
Mobile
Tel
STD Code
EMail

Work Address
Pin Code
Tel
STD Code
EMail

Date of Birth:

Gender: Female Male

Education History

Professional Qualifications Name of University/Institution Specialization Year Marks/Percentage
MBBS:
MD/Diploma:
Others

Details of Current Employment

Name, Address and Brief Information about the Organization:
Designation and Job Description:
Date of Commencement of Employment:

Employment History

Please provide details of all positions held - starting with your present employment and going back to the first - in the space below:
Organization Designation Key Responsibilities Duration (in months)

Public Health Programme(s)

Please provide brief details of prior exposure to the given Public Health (PH) programmes in the space below:
PH Programme Details of Exposure / Responsibilities Handled Exposure (in months)
Polio:
Tuberculosis:
HIV/AIDS:
Tobacco Control:
Maternal Child Health:
Reproductive Child Health:
Family Planning:
Leprosy:
Malaria & Vector Borne Diseases:
Integrated Management of Neonatal and Childhood Illnesses:
Epidemiology:
Others

Supervisory/Training Responsibilities

Please provide brief details of experience of supervision/ imparting training possessed by you, with any public health programme.

Locations

Kindly check those locations which will be preferred by you for posting:
Andaman and Nicobar IslandsAndhra PradeshArunachal Pradesh
AssamBiharChandigarh
ChhattisgarhDadra and Nagar HaveliDaman and Diu
DelhiGoaGujarat
HaryanaHimachal PradeshJammu and Kashmir
JharkhandKarnatakaKerala
LakshadweepMadhya PradeshMaharashtra
ManipurMeghalayaMizoram
NagalandOrissaPondicherry
PunjabRajasthanSikkim
Tamil NaduTripuraUttar Pradesh
UttaranchalWest Bengal

Condition of Transferability

(Positions are transferable and candidates may be posted to any part of the country based on the needs of the job.)

Acceptable:

Computer Knowledge

Software/ApplicationLevel

Language Proficiency

LanguageAbility to ConverseAbility to ReadAbility to Write

Additional Space

Please use the space below to elaborate on answers for which you found the form allowed too little space.