ONLINE APPLICATION UNDER THE DIRECTORATE OF MEDICAL EDUCATION, ASSAM (HEALTH-B)
The fields, which are marked with asterisk (*) are mandatory fields.
*Post Applied for
*Name of Applicant
*Date of Birth (As per Matriculation Cerftificate)
*Gender
*Caste
*Mobile No
E-Mail ID
*Father's Name
*Mother's Name
*Nationality
*Are you a Person with Disability (PWD) ?

Correspondence Address

*C/O:
*House No.:
*Vill/Town:
*Post Office:
*Police Station:
*District:
*PIN:
*State

Permanent Address

*C/O:
*House No.:
*Vill/Town:
*Post Office:
*Police Station:
*District:
*PIN:
*State
*Essential Qualification (As per advertisement)
Qualification Name of Course Course Duration in year Course start date Course end date Institute Name University Name Mode of Course Subjects Year of passing % of Marks obtained Division/ Class /Grade
Qualification Details
Exam Passed Name of Degree Subject Stream Institution Name University Name Course Duration in year Year of passing % of Marks Division/ Class /Grade Full Time/ Correspondence/ Distance
* 10
*10+2
Degree
PG
Professional Qualification
Other Qualification
Registration No.(For Technical Education)
Registration under
Registration No.
Training Details
Training Name Place of Training From Date To Date
Experience Details
Name of Organization Designation Nature of duty From Date To Date Year of Service (YY/MM)
*Total Experience in months
*Date of joining under NHM or any other Health Programme under H&FW Dept., Assam
Computer Proficiency
Are you proficient in Computer?
*Upload Passport size Photo (Max file size 50 KB, Only .jpg/.gif/.png format allowed)
Remarks if any(Max 255 words allowed)
Declaration