Himanchal Pradesh: Community Health Officer, 2021

Personal Details

Aadhaar Number*

Full Name* (as in 10th document)

Father's Name*

Category*

eMail*

Mobile Number*

Date of Birth*

Gender*

Belong to EWS Category?*

Ward of Freedom Fighter?*

Belong to IRDP Category?*

Bonafide resident of Himachal Pradesh?*

Address

Permanent Address and Correspondence Address are same ? Yes No

Correspondence Address

*Address Line 1
Address Line 2
*City	*Pin Code	*District
*State

Permanent Address

*Address Line 1
Address Line 2
*City	*Pin Code	*District
*State

Education Qualification

Degree/Certificate	Completed	Name of the course completed	University/Board	Year of Passing	Percentage
B.Sc. Nursing /Post basic B.Sc. Nursing
Integrated Course of Mid Level Health Provider
Bridge Programme for Certificate in Community Health (BPCCH) Course certified by IGNOU
Senior Secondary Education (+2)
Secondary Education (Matriculation)

Other Essentials Required Details

*Do you have any working experience as CHO in Health Wellness Centre -Health Sub Centre

Months (in figure)

Name of the Health Wellness Centre -Health Sub Centre, where deployed

DECLARATION:
I declare that the above information declared/ furnished by me are true and correct to the best of my knowledge and belief. I am aware that if at any point of time, the information furnished by me are found to be incorrect or false, my candidature is liable to be rejected in the selection process.