Serial No.

OFFICE OF THE HOSPITAL DIRECTOR

QAZI HUSSAIN AHMAD MEDICAL COMPLEX,
MTI, NOWSHERA

Application form for Employment

Post Applied For

Instruction: This application form, duly completed should be submitted to the Hospital Director Office,
Nowshera on or before the due date along with.
i. Attested photocopies of certificates, degrees, detail marks certificates, domicile and other
relevant documents.
ii. Persons already in employment should submit their application forms through proper channel
along with NOC issued by the competent authority.
iii. Incomplete application forms and those received after the due date will not be entertained.
iv. Use additional sheets, if required.
1. Name (in block letters)

2. Father’s Name
3. Address and other particulars:
i. For correspondence (interview call) …………………………………………………

………………………………..………………………………………………….………

Mobile …………………………………………. Ph. No. …………………………….

ii. Permanent Home Address: ………………………………………………………….

………………………………………………….. Ph. No. …………………………….

iii. E-Mail Address ………………………………. Gender. …………………………...

iv. Province of Domicile …………………………. v. Nationality ………………………

vi. Marital Status ………………………………… vii. Date of Birth …………………...

4. Education: Commencing from the Matriculation or Equivalent Examination.

Sr. Certificate/ Name of Board/ Exam. With year Division/ Attempt Obtained/
No Degree University of passing Distinction Total Marks
1. MBBS
Exam Obtained Total
1st Prof
2nd Prof
3rd Prof
Final Prof
Total

2. FCPS

3.

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 5. Formal Training or Education:

Period
Sr. No Name of Institution Type of Training Certificate or Diploma obtained
From --- To

6. Research Papers: Attach list of Research Papers as per specimen and attested
photocopy of title journal with research paper.

Sr. No Title of Research Paper Name of Journal Date of Publication Principal or co-author

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7. Employment Record (Starting from the present position):
Sr. Name of From To Total Designation Nature of Job
No Institute Experience (Permanent/
Organization Temporary)

8. Attach List of Miscellaneous Teaching or Administrative Experience, if any.

9. Membership of Learned Societies and other Achievements in the University, Public or

International Affairs, if any.

10. Countries Visited:

Sr. No Name of Country Duration Purpose of Visit

11. References:
i.

ii.

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 12. List of attested documents attached. Page No.

i. C.V
ii. Matric (S.S.C.)
iii. Intermediate (F. A/ F. Sc.)
iv. MBBS Degree
v. FCPS/MPhil/MPH/Phd Degree
vi. DMC/ Academics Certificates(MBBS)
vii. PM&DC Registration of MBBS /FCPS/MPhil/MPH/Phd
viii. PM&DC eligibility certificate
ix. PM&DC faculty registration
x. NoC for faculty transfer
xi. Experience Certificates
xii. Domicile Certificate
xiii. C.N.I.C
xiv.
xv.
xvi.
xvii.
xviii.
xix.

I hereby solemnly declare and affirm on oath, that all the entries made in this
application form and documents attached herewith are genuine, true and correct to the best of
my knowledge and belief on that nothing has been concealed.

Name & Signature of the Candidate Dated: / / 2019

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