Enter Mobile Number of Doctor
*
Government of Punjab
EMPANELMENT OF MEDICAL OFFICER FOR HEALTH CLINICS/HEALTH & WELLNESS CENTERS/MOHALLA CLINICS IN URBAN & RURAL AREAS BY THE DEPARTMENT OF HEALTH & FAMILY WELFARE PUNJAB
Mobile No :
Preferred Districts
Preferences
1.
2.
3.
4.
5.
Following Stations has been selected
S.No
District
Preferred Station
Your Preference Priorty
Basic Information
Note 1:Name and DOB as recorded in the Matriculation Examination Certificate.
Name
*
Father Name
*
Mother Name
*
Date Of Birth
*
Gender
*
Nationality
*
Category
*
Marital Status
*
Punjabi passed upto Matric Standard
*
`
Address Detail
State
*
District
*
Zip Code
*
Rural/Urban
*
City of Residence
Address Line 1
*
Address Line 2
Mobile Number
*
Email
*
Higher Education Details
Degree
Board/University
Year Wise
Year of Passing
Maximum Marks
Obtained Marks
Percentage
MBBS
1st Year
2nd Year
3rd Year
4th Year
Foreign Medical Graduate
Foreign Board/University
Foreign Country
Foreign Year of Passing
Foreign Percentage
Foreign Medical Examination conducted by National Board of Examination
Foreign Exam
Year of Passing Foreign
PG Diploma
Board/University
Specialization
PG Year of Passing
PG Diploma Percentage
PG Degree
Board/University
Specialization
PG Year of Passing
PG Diploma Percentage
Others
Covid-19 Duty Experience under Health Department, Punjab or Medical Education Department, Punjab
Sno
Name of Employer
Designation
Exp Sector
Nature of Duty
From Period
To Period
1
2
3
Experience
Sno
Name of Employer
Designation
Exp Sector
Nature of Duty
From Period
To Period
1
2
3
Other Information
Any legal and/or criminal case pending before any Court/Investigating Agency
*
Whether Convicted by any Court of Law
*
Registration with PMC/MCI
*
Knowledege of Computer
*
Name and Address found Correct ?
Yes
No
Date of Birth Found Correct ?
Yes
No
MBBS Qualification Found Correct ?
Yes
No
Not Filled
Registration MCI/SMC registration Correct?
Yes
No
In case of Foreign Medical Graduate, MCI/SMC registration valid ?
Yes
No
Not Filled
PG Diploma Found Correct ?
Yes
No
Not Filled
PG Degree Found Correct ?
Yes
No
Not Filled
Covid Experience Found Correct ?
Yes
No
Not Filled
General Experience Found Correct ?
Yes
No
Not Filled
If Computer Course yes and Document Provided ?
Yes
No
Remarks, if any document or information found incorrect ?