RUHS Recruitment Form 2024

Personal Details
Candidate Photo
Application Status Registration Numbe First Name
PaymentSuccess r SYED
10003961
Middle Name Last Name
MOHAMMED AMJAD
Father's Name Mother's Name Are you registered
SYED MOHAMMED SABIRA SYED with any State Dent
ASLAM al Council?:
Yes
Registration Type: Name of State of De State Dental Council
Permanent ntal Council Registration Numbe
Rajasthan r:
A11084
Date of Registration Valid upto/renewed
15/05/2024 upto
31/12/2028
Other Personal Details
Mobile No Email ID
8619790400 dramjad0400@gmail.
com
ID Proof ID No. Domicile
Other 691737349311 RAJASTHAN
Gender Religion Marital Status
Male MUSLIM Unmarried
Category Details
Category
OBC-NCL
Miscellaneous Details
Do you have Practic
al Knowledge of Hin
di Language in Devn
agri Script (lipi) and
Culture of Rajastha
n? क्या आपको देवनागरी
लिपि में हिंदी भाषा का व्य
वहारिक ज्ञान एवं राजस्थान
की संस्कृ ति का व्यावहारिक
ज्ञान है?:
Yes
Additional Category Details
Whether you are Pw Whether you are an Date of Birth (DD-M

D? Ex-Serviceman ? M-YYYY)
No No 13/Feb/1996
Age as on 01st Janua
ry 2025
28 Years 10 Months 1
9 Days
Correspondence Address
Address Line 1 Address Line 2 Country

POWER HOUSE ROAD MARIYAM SYED India
WARD NO-8 MANZIL RATANGARH
State District City/Town/Village
Rajasthan Churu RATNGARH
Pincode/Postal Code Is Permanent Addre
331022 ss Same as Correspo
ndence address?
Yes
Permanent Address
Address Line 1 Address Line 2 Country

POWER HOUSE ROAD MARIYAM SYED India
WARD NO-8 MANZIL RATANGARH
State District City/Town/Village
Rajasthan Churu RATNGARH
Pincode/Postal Code
331022
Matric/High School Details
Name of Board Year of Passing Duration of Course

RBSE 2012 (Number):
1
Duration of Course No. of Attempts
(Month/Year): 1
Year
10+2 or equivalent examination Details
Name of Board Year of Passing Duration of Course

RBSE 2015 (Number):
1
Duration of Course No. of Attempts
(Month/Year): 1
Year
UG Degree Details
Duration of Completio
n of BDS course exclud
ing internship (In Year
s).
5
Sr. No. Number % of Ma Year of Name O Universi City Na State Na

of attem rks Passing f College ty me of yo me of yo
pts ur Colle ur Colle
ge ge
1 2 54 2017 JAIPUR MAHAR JAIPUR RAJASTH

DENTAL AJ VINYA AN
COLLEG K GLOB
E AL UNIV
ERSITY

DENTAL AJ VINAY AN
COLLEG AK GLO
E BAL UNI
VERSITY

DENTAL AJ VINAY AN
COLLEG AK GLO
E BAL UNI
VERSITY

DENTAL AJ VINAY AN
COLLEG AK GLO
E BAL UNI
VERSITY
Internship Details
Have you completed Place of Internship:

your Internship ?: JAIPUR DENTAL
Yes COLLEGE
Date of Completion
of Internship:
17/06/2021
PG Details
Do you have PG Deg

ree?:
No
Employment Details
Have you ever rende Are you presently w

red services in State orking at any Organi
Service or Presently sation?:
Working ?: No
No
Institute Details
Name of Institute la
st attended:
JAIPUR DENTAL
COLLEGE
Responsible Officer for Reference/ Verification - First Officer Details
Name: Designation: Address:

DR SYED SENIOUR TEACHER POWER HOUSE ROAD
MOHAMMED ASLAM WARD NO-8
MARIYAM SYED
MANZIL RATANGARH
DIS CHURU
Mobile No:
9887131698
Responsible Officer for Reference/ Verification - Second Officer Details
Name: Designation: Address:

RAKESH KATHAK VICE PRINICIPLE NEAR ASHOK
ASTHAMB RAILWAY
NO -FOURTH BRIDEG
RATANGARH DIS
CHURU
Mobile No:
9079111604
Additional Details
Whether you have e

ver been penalized,
removed or blacklist
ed, if yes then menti
on the section unde
r which penalized an
d also mention the p
enalty?
No
Payment Details
Amount Transaction ID Order ID

5000 19943803668 100039612024052114
2852
Document Upload Details
Captured Photo Signature
View / Downlo
Document
ad
To view your Scanned Left Thumb Impression with Blue In

Click here.
k:
To view your Scanned Right Thumb Impression with Blue I

Click here.
nk:
To view your Scanned State Dental Council Registration C
Click here.
ertificate.:
To view your Scanned UG Marksheets: Click here.
To view your Scanned UG attempted certificate: Click here.
To view your Scanned Caste Certificate: Click here.
To view your your Scanned entered/filled ID proof: Click here.
To view your your Scanned Internship Completion Certific

Click here.
ate:
Declaration
I hereby declare that all the information given by me in support of my applic

ation is true, complete and correct to the best of my knowledge and nothing
has been hidden by me. If any of them is found to be incorrect or false, I sha
ll be liable to any legal action and / or termination from the services as may
be deemed fit by the appointing authority.

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Personal Details

Other Personal Details

Additional Category Details

Whether you are Pw Whether you are an Date of Birth (DD-M

Address Line 1 Address Line 2 Country

Address Line 1 Address Line 2 Country

Matric/High School Details

Name of Board Year of Passing Duration of Course

10+2 or equivalent examination Details

Name of Board Year of Passing Duration of Course

Sr. No. Number % of Ma Year of Name O Universi City Na State Na

1 2 54 2017 JAIPUR MAHAR JAIPUR RAJASTH

2 3 55 2018 JAIPUR MAHAR JAIPUR RAJASTH

3 1 55 2019 JAIPUR MAHAR JAIPUR RAJASTH

4 1 61 2020 JAIPUR MAHAR JAIPUR RAJASTH

Have you completed Place of Internship:

Do you have PG Deg

Have you ever rende Are you presently w

Responsible Officer for Reference/ Verification - First Officer Details

Name: Designation: Address:

Responsible Officer for Reference/ Verification - Second Officer Details

Name: Designation: Address:

Whether you have e

Amount Transaction ID Order ID

Document Upload Details

Captured Photo Signature

To view your Scanned Left Thumb Impression with Blue In

To view your Scanned Right Thumb Impression with Blue I

To view your Scanned UG Marksheets: Click here.

To view your Scanned UG attempted certificate: Click here.

To view your Scanned Caste Certificate: Click here.

To view your your Scanned entered/filled ID proof: Click here.

To view your your Scanned Internship Completion Certific

I hereby declare that all the information given by me in support of my applic

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