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Application Form
(*) Fields are Mandatory.
Applicant Details
Personal Details
*Apply For
--Select--
Medical Officer Class-II
*CPS PG Certified?
Yes
No
*First Name
*Middle Name
*Last Name
*Email ID
*Date of Birth
*Mobile No
*Gender
Male
Female
*Category
--Select Category--
SC
ST
OBC
GENERAL
*Address
*Pin Code No.
*Whether he/she is bonded (For MBBS MO only)?
Yes
No
*Select Disability
Yes
No
% of Disability
*
Educational Details
*MBBS persued from abroad?
Yes
No
Name Of Degree
Passing Year
Final Year Total Marks
Final Year Obtained Marks
Percentage
No of Attempt(in numbers only)
*Name of Medical College
*Name of University
*Gujarat Medical Council Registration Number
(ex. 'G' or any Letter only)
(enter only numeric part only)
*Date
*Period of Internship
*From Date
*To Date
Additional Qualification
*
Experience Details
*Do you have any work experience with State Government?
Yes
No
Preferred Locations(All three are mandatory)
Sr No.
District
Taluka
Center Type
Center
1
--Select--
MAHESANA
DAHOD
PANCHMAHAL
CHHOTAUDEPUR
GIR SOMNATH
SURAT
VADODARA
NARMADA
RAJKOT
AMRELI
NAVSARI
ANAND
MAHISAGAR
AHMEDABAD
MORBI
BHAVNAGAR
DEVBHUMI DWARKA
KHEDA
PORBANDAR
GANDHINAGAR
JAMNAGAR
VALSAD
KACHCHH
THE DANGS
BHARUCH
ARAVALLI
SABARKANTHA
SURENDRANAGAR
TAPI
JUNAGADH
PATAN
BANASKANTHA
BOTAD
--Select--
Primary Health Center
Community Health Center
SubDistrict Hospital
General Hospital
UPHC
Director,Workers State Insurance Scheme
2
--Select--
MAHESANA
DAHOD
PANCHMAHAL
CHHOTAUDEPUR
GIR SOMNATH
SURAT
VADODARA
NARMADA
RAJKOT
AMRELI
NAVSARI
ANAND
MAHISAGAR
AHMEDABAD
MORBI
BHAVNAGAR
DEVBHUMI DWARKA
KHEDA
PORBANDAR
GANDHINAGAR
JAMNAGAR
VALSAD
KACHCHH
THE DANGS
BHARUCH
ARAVALLI
SABARKANTHA
SURENDRANAGAR
TAPI
JUNAGADH
PATAN
BANASKANTHA
BOTAD
--Select--
Primary Health Center
Community Health Center
SubDistrict Hospital
General Hospital
UPHC
Director,Workers State Insurance Scheme
3
--Select--
MAHESANA
DAHOD
PANCHMAHAL
CHHOTAUDEPUR
GIR SOMNATH
SURAT
VADODARA
NARMADA
RAJKOT
AMRELI
NAVSARI
ANAND
MAHISAGAR
AHMEDABAD
MORBI
BHAVNAGAR
DEVBHUMI DWARKA
KHEDA
PORBANDAR
GANDHINAGAR
JAMNAGAR
VALSAD
KACHCHH
THE DANGS
BHARUCH
ARAVALLI
SABARKANTHA
SURENDRANAGAR
TAPI
JUNAGADH
PATAN
BANASKANTHA
BOTAD
--Select--
Primary Health Center
Community Health Center
SubDistrict Hospital
General Hospital
UPHC
Director,Workers State Insurance Scheme