House Officer Application Perfoma
House Officer Application Perfoma
House Officer Application Perfoma
I) I do hereby solemnly declared that the informaiton given by me in this applicatin form is true and correct to the
best of my knowledge and believe. I fully understand that the facts given above will serve as the basis for
determinatin of my eligibility by the concerned Authorities. My candidature so determned by the Board / Authorities
will stand provisional until, it is verified with the original certificates at the time of interview. I will not claim benefit
of any information which is not mentioend in the application form and is proceed later on.
II) i declared that i have not been already employed anywhere for House Job and I am submitting my applicatoin
through proper channel and I will ensure that I shall resigned from my existing post (if any) when selected.
III) I undertake to serve for the terms of one Year in case of Selection as an Internee House Surgeon / Physician.
IV) I solemenly declared that I shall be legally bound to surrender my security of Rs. 1000/- in case i leave House Job
before due date.
V) I undertake to produce the registration of PMC.
VI) I have also read the rules and regulations and I am submitting the Affidavit on Judicial Paper worth Rs. 50/- duly
signed and attested by the Oath Commissioner.
I also understand that after the submission of application, if my application stands incomplete, wrongly filled,
unsignd or misstated in the aove replies, disciplinary action shall be taken against me under the rules.
AFFIDAVIT
2. I will not take part in any sbuversive activities i.e. strikes, demonstrations, slogans, etc.
3. I will be bound to abide by the rules, regulations and orders issued by the Hospital Authorities. i have read the
rules and regulations carefully.
4. That if, I am found indulged in any such activities and violations of rules and regulations, my House JOb will be
liable to be terminated without assigning any notice.
Signature:- ________________________________
Name:- DR._________________________________
S/O, D/O, W/O ______________________________
Phone No. (Res). ___________________________
Mobile No. _______________________________
Address:- __________________________________