22.01.2012 POST-GRADUATE ( PG DENTAL) COURSES IN S.C.B. DENTAL COLLEGE & HOSPITAL, CUTTACK, ORISSA ODISHA

22.01.2012 POST-GRADUATE ( PG DENTAL) COURSES IN S.C.B. DENTAL COLLEGE & HOSPITAL, CUTTACK, ORISSA ODISHA
-1-
POST-GRADUATE (DENTAL) SELECTION – 2012
ODISHA
PROSPECTUS
FOR

SELECTION OF CANDIDATES
FOR
POST-GRADUATE (DENTAL) COURSES IN
S.C.B. DENTAL COLLEGE & HOSPITAL, CUTTACK
APPROVED BY THE
DEPARTMENT OF HEALTH & FAMILY WELFARE,
GOVERNMENT OF ODISHA
(Vide Letter No -26524 / H Dt. 13.12.2011)
Along with the application form candid ate is to enclose A/c payee Bank Draft of
`. 1,500/- (Rupees One Thousand Five Hundred only) (in original) drawn in
favour of “ENTRANCE EXAMINATION FEES” Payable at State Bank of India,
HOD Branch, Bhubaneswar (Code No. 10249)
Note: The admission of the candidates is subject to renewal of permission in Oral Pathology
& Microbiology by Govt. of India, Ministry of Health & Family Welfare for the academic
session2012-13.-2-
IMPORTANT INFORMATION
1. The Prospectus & Application Forms will be available in Govt. Website i.e.
www.dmetorissa.gov.in (ALL EXAMINATIONS) from 14.12.2011. No printed Prospectus
& Application Forms will be sold in the counter of the Dental College.
2. Last date & hour of receipt of Application Forms …… 31.12.2011, by 5 P.M
3. Date of Entrance Examination:……………..………… 22.01.2012
4. Dates of Counselling :………………………………… 17.02.2012 & 18.02.2012
5. Last date up to which students can be admitted …… 31.05.2012
against vacancies arising due to any reasons.
As per direction of Honorable Supreme Court of India dated 16.5.2007 passed in SLP( C) No.
24295/2004, SLP No. 14356/2005, WP (C) No.173/2006 and SL P (C) No. 24296-24299/2004
“If any incident of ragging comes to the notice of the authority, the concerned student shall be
given liberty to explain and if his/her explanation is not found satisfactory, the authority would
expel him/her from the institution as well as criminal proceedings will be instituted as per law”.
Contact address: Convenor, PG (Dental) Selection Committee -2012 &
Principal, SCB Dental College & Hospital, Cuttack, 753 007
e-mail: [email protected],-3-
PROSPECTUS FOR SELECTION OF CANDIDATES
FOR PG (DENTAL) COURSES IN THE
S.C.B. DENTAL COLLEGE & HOSPITAL, CUTTACK – 2012
(PLEASE READ THESE INFORMATION CAREFULLY)
(INCOMPLETE, ILLEGIBLE AND INCORRECT APPLICATIONS WILL BE SUMMARILY REJECTED )
1. GENERAL INFORMATION:
Selection of candidates for PG (Dental) Courses in S.C.B. Dental College & Hospital, Cuttack
affiliated to Utkal University of Odisha shall be conducted by the PG (Dental) Selection Committee.
The PG (Dental) Selection Committee – 2012 shall consist of :
(i) Director, Medical Education & Training, Odisha, Bhubaneswar – Chairman
(ii) Dean & Principal, S.C.B. Medical College, Cuttack – Member
(iii) Principal, S.C.B. Dental College & Hospital, Cuttack – Convener
(iv) Professor & HOD, OMFS – Member
(v) Professor & HOD, Oral Pathology & Microbiology – Member
Applications in the prescribed form are invited for selection of candidates for the P.G. (Dental)
Courses available at S.C.B. Dental College & Hospital, Cuttack (Utkal University) for the year 2012-13.
2. COMMENCEMENT OF SESSION:
The admission will be made once a year. The academic session commences from 1
st
May,
2012 unless otherwise notified.
3. DURATION OF THE COURSE:
3.1. The PG (Dental) Courses are of 3 years duration from the date of joining.
3.2. Admissions to PG (Dental) Courses in the subject of Oral Pathology & Microbiology are
subject to renewal of permission by the Central Govt. for the academic session 201 2-13.
4. AVAILABILITY OF SEATS:
Name of Subject Seats Allotted Central Govt. Quota State Quota
Oral & Maxillofacial
Surgery
2 1 1(Direct)
Pedodontics &
Preventive Dentistry
2 1 1(In-service)
Oral Pathology &
Microbiology
2 1 1(In-service)
NB: The distribution of seats under direct and in -service category for the next academic session will be
on rotation basis.-4-
5. ELIGIBILITY CRITERIA OF CANDIDATES:
At the time of application the candidate must have passed B.D.S. degree examination from an
institution recognized by Dental Council of In dia fulfilling all criteria laid down by Dental Council
of India as eligibility / qualifying criteria and has obtained registration either from the Dental
Council of India or any of the State Dental Council after passing the final B.D.S. Examination
and has already completed / completing one year (12 months) Compulsory Rotating
Internship in a recognized Dental College by 31
st
March, 2012 and must be:
5.1. A permanent resident of Odisha and required to furnish a certificate of permanent
residence of Odisha from a Revenue Officer not below the rank of Tahasildar of the area
concerned (in Appendix – II)
OR
5.2. The Son/Daughter/Spouse of any one of the following category
5.2.1. Employees of Government of Odisha
5.2.2. All India Services belonging to Odisha Cadre serving within or outside Odisha
5.2.3. Public Sector undertaking of either State of Odisha or Govt. of India located in Odisha
5.2.4. Defense Services personnel stationed in Odisha (to furnish the certificate as per
Appendix – III)
5.3 Candidates who have completed PG (Dental) Course or studying PG (Dental) in any subject
shall not be eligible to apply for PG (Dental) Course.-5-
6. CATEGORY OF CANDIDATES:
6.1 A Direct Candidate is one who at the time of application:
6.1.1 Is son/daughter/ spouse of a person who has served in Defense Service for minimum of
5 years by 31st December 2011.
6.1.2 Is either unemployed or in the employment of Government of Odisha, but not completed
five years of service which includes all categories of employment like contractual / temporary / adhoc/ regular by 31st December, 2011
6.1.3 Is in the employment of Govt. of Odisha Public Sector Undertakings/ Govt. of India
public sector undertakings located in Odisha. The employer has to sponsor the candidates
for entire period of course & must submit the sponsorship certificate as in Appendix IV.
6.2 An In-service candidate is one who at the time of application:
6.2.1 Is in the employment in Government of Odisha and has completed a l e n g th of 5
years of service which includes all categories of employment like contractual / temporary / adhoc/ regular by 31st December, 2011, excluding at a stretch leave of any kind of 30 days or
more. However the maternity leave is exempted from this exclusion and shall be counted
towards the length of five years of service.
Note: In-service and Direct candidates in employment under Government of Odisha at
the time of application are advised to submit their applications along with the
required documents directly to the Convenor, P.G. (Dental) Selection Committee –
2012, under intimation to their Employer. Copy of such intimation is to be attached.
7. DOCUMENT TO BE SUBMITTED ALONG WITH APPLICATION:
Self-attested photocopy of the following documents should be submitted:
7.1. Certificate of Board of Secondary Education / Matriculation / 10
th
Class Pass Certificate
or equivalent in support of the Date of Birth of the Candidate
7.3. B.D.S. Degree or Provisional B.D.S. Pass Certificate issued by the concerned University
7.4. Completion / Continuation Certificate of Compulsory Rotatory Internship /
Housemanship, issued by the Principal / Superintendent of the Medical College / Dental
College & Hospital concerned by 31
st
March, 2012.
7.5. Permanent Dental Registration Certificate Sta te / Central Dental Council of India
7.6. Three attested recent colour photographs of size 40×50 mm should be attached to the
space provided in the Application Form, Admit Card and Attendance Card (in addition,
One recent Colour photograph of size 40×50 mm is to be pasted on Medical Certificate
(Appendix – V).-6-
7.7. Certificate from competent authorities in support of eligibility criteria claimed under
Clause No. 5 (Necessary documents may be furnished in support of the claim made by
the applicant in Appendix I, II, III as applicable).
7.8. In-Service candidates who have rendered the required length of service as per Clause
No. 6.1 must submit a certificate from the concerned C.D.M.O.(s) or appropriate
authorities in support of his / her claim stating therein chronologically the place of
posting, duration of service including Contractual, Temporary, Ad -hoc and Regular
postings, the respective places and the Block and the Dist rict to which the place belongs
(as per Appendix – I). Leave period exceeding 30 (thirty) days at a stretch shall not be
counted towards the length of service.
7.9. Certificate in support of children or spouse of service personnel / ex -service personnel
(Appendix – III).
7.10. Original and a Xerox copy of the Bank Draft of `.1,500/- drawn in favour of “ENTRANCE
EXAMINATION FEES” payable at State Bank of India, HOD Branch, Bhubaneswar
(Code No. 10249)
Note: (I) Appendix Forms to be enclosed along with the Application Form.
(II) Adequate postage stamps to be affixed in the space provi ded for in the
Application Form
8. PROCEDURE FOR SUBMISSION OF APPLICATION
Application form and the relevant formats in appendices in prospectus are to be obtained from the
website i.e. www.dmetorissa.gov.in. and complete application in prescribed form along with relevant
documents is to be sent to “Convenor & Principal, PG (Dental) Selection Committee – 2012, S.C.B.
Dental College & Hospital, Cuttack, Odisha, PIN – 753 007” by Registered Post / Speed Post only.
Application received by any other mode shall be rejected.
All relevant documents should be tagged (not stapled) together to the Application Form securely
and serially.
Not more than one application should be sent in one envelope. In case, more than one applica tion
is received in one envelope, all shall be rejected.
Applications received incomplete in any respect or after the prescribed last date or addressed to
any agency other than the Convenor shall be rejected.
Request for any alteration, addition, correct ion or modification etc. of entries in the application
already submitted will not be entertained.
9. METHOD OF SELECTION OF CANDIDATES
9.1. Candidates belonging to both direct and in -service category shall be selected through an
Entrance Examination. The Entrance Examination shall be conducted at the centre as
decided by the Selection Committee. No TA / DA will be paid for attending the said
Examination.
9.2. The Syllabus for the competitive Entrance Examination for admission to the PG (Dental)
Courses shall be that of BDS standard and shall cover all the subjects taught during the
BDS course as per DCI Syllabus. There will be only one paper of 3 hours duration
(10.00 AM to 1.00 PM) containing 200 MCQs. The approximate distribution is as under:
General Human Anatomy, General Human Physiology
and Biochemistry, Dental Materials, General & Oral
Pathology and Microbiology, General & Dental
100 MCQs-7-
Pharmacology and Therapeutics, General Medicine,
General Surgery, Preventive & Community Dentistry
Prosthodontics with Crown and Bridge, Conservative
Dentistry including Endodontics, Pedodontics, Oral
Surgery including General Anesthesia, Periodontics,
Orthodontics, Oral Medicine & Radiology.
100 MCQs
9.3. There shall be four different choices of each question. Candidates should choose the
correct choice amongst them. All questions will be of objective type (MCQ).
10. CONDUCT OF EXAMINATION
10.1. The Entrance Examination will be conducted at centers as decided by the PG (Dental)
Selection Committee – 2012 on the date and time as will be indicated on the Admit Card.
10.2. Change of Examination Centre is not permissible.
10.3. A candidate, who does not possess the Admit Card issued by the Convenor, shall not be
admitted to the Examination hall under any circumstances.
10.4. Candidates are to occupy their seats 30 minutes before the commencement of the
Examination.
10.5. No candidate shall be admitted to the Examination Hall after commencement of the
Examination. Similarly, no candidate will be allowed to leave the Examination Hall
before the examination is over.
10.6. No candidate shall be allowed to carry any electronic device, textual material printed or
written, except Admit Card (without envelope) into the Hall.
10.7. Shifting or change of seats shall be counted as an act of misconduct and candidate shall
forfeit the right to continue writing further in the Examination.
10.8. The candidate shall maintain silence and attend to his / her paper only. Any one causing
disturbance in the Examination Hall shal l forfeit the right to continue writing further in the
Examination.
10.9. Sealed packets of Question & Answer Booklet (Q & A Booklet) shall be opened and
given to the candidates 5 minutes before the commencement of the Examination.
10.10. Candidates are to count the number of pages of the Q & A Bookl ets examine for any
deficiencies and report discrepancy, if any, to the invigilat or in writing immediately within
10 minutes of receiving the Q & A booklet for rectification for the same and thereafter no
further complaints will be entertained. The decision of the Centre Superinten dent shall be
FINAL AND CONCLUSIVE regarding the conduct of candidate in the Examination Hall /
Centre.
10.11. Except putting the relevant entries in the Q & A Booklets as instructed, any additional
writing, overwriting or any other marks in any form, disfigurin g, folding, mutilating, soiling
of the Q & A Booklet shall deemed to be an act of misconduct and shall be liable for
cancellation of his / her Booklet.-8-
10.12. In case the candidate finished answering earlier, he / she shall hand over the Q & A
Booklet personally to the concerned invigilator of the hall and remain seated in the
allotted seat till the examination is over.
10.13. It is the duty of the candidate to hand over personally his / her Q & A Booklet to the
invigilator of the Examination Hall
10.14. Any other instruction issued to the candidates in the Examination Hall shall be treated as
part of the Prospectus.
10.15. C a r r y i n g of Cellular Phones, Pagers, Calculators and any other electronic
communication equipment are strictly prohibited. Anyone found to have any electronic
gadget in the hall will forfeit the right to continue in the examination. The gadget and the Q
& A booklet will be seized. The gadget will be returned after the decision of the Board
members. Hence the candidates should not bring any such prohibited items to the venue
of examination as there is no provision to keep them at the venue.
11. EVALUATION OF ANSWERS OF ENTRANCE EXAMINATION
11.1. All questions will be single response objective type (Multiple Choice) only. The marks
will be awarded as follows:
Response Marks
Correct 4 (Four)
Incorrect, more than one response, blank answer box. – 1 (Minus One)
Answer box marked “X” or, cutting, erasing, overwriting or
writing with pencil
0 (Zero)
Note: During the process of evaluation if any question or its choice answers are found to be
ambiguous then the same question(s) shall be evaluated by pro -rata basis as per the
Judgment of Hon’ble Supreme Court, passed in the case of Pankaj Sharma & others vs.
State of Jammu & Kashmir.
11.2 ADDITIONAL WEIGHTAGE:
Those in-ser vice candidates who have completed minimum of thr ee year s
ser vic e in KBK/Tr ibal/Back war d ar eas & have qualified in the Entrance Examination
shall be awarded an additional weightage of 10% marks secures in the MDS Entrance
Examination. Additional weightage of 5 % of marks secured in the MDS Entrance
Examination shall be awarded to the rest of the in -service candidates who have
qualified in the examination.
12. RESULTS
12.1. Candidates securing 50% of total marks shall be eligible for selecti on and a provisional
merit list shall be prepared of all the eligible candidates.
12.2. The Merit lists shall be published in the website i.e. www.dmetorissa.gov.in
(ALL EX AMIN ATIO NS ). The result of the individual candidate will not be
intimated by post.
12.2.1. For eligible In-service candidates, after adding the credit marks for serving in
Rural / Tribal / Backward areas, if any, a “Common Merit List” with their rank shall
be prepared.-9-
12.2.2. For eligible direct candidates a “Common Merit List” with their rank shall be
prepared.
12.3. While preparing merit lists, in case of two or more candidates securing equal marks the
ranking shall be decided in order of preference as under:
12.3.1. Candidate securing higher marks in the subject applied for in his B.D.S.
Examination.
12.3.2. If this is equal, the elder, according to the date of birth furnished, will get
preference over the younger
13. COUNSELLING FOR ADMISSION:
The candidates will be selected for admission by Counseling from the Merit lists prepared.
13.1. The date, time and venue of Counseling shall be intimated to the eligible candidates in
the call / intimation to be sent by Regd. / Speed Post / Electronics Media / News Paper /
any other speediest means.
13.2. No TA / DA shall be paid for attending the Counseling.
13.3. During Counseling the candidates must produce the Original Admit Card along with the
original documents (Copies of which they have already submitted with the Application
Form).
13.4. Candidates failing to appear for counseling in the time & date schedule / unable to
provide required documents, would forfeit the seat.
13.5. If any seat falls vacant after the Counseling and admission including the vacant seats of
All India Quota, the Selection Committee may go for second round of Couns eling on
another date subject to approval of the Govt. No admission will be allowed beyond the
cut-off date i.e. 31
st
May, 2012.-10-
14. SELECTION OF CANDIDATES
14.1. Candidates shall be selected in order of merit ( In-service & Direct)
14.2. Selection of Candidates:
14.2.1. In case of non-availability of candidates against In-service seats, the seats may
be filled up by Direct candidates and vice-versa.
14.2.2. Unfilled “All India Seats”, if any, will be fulfilled by as per the decision of the
selection committee on the spot of couns eling.
15. ADMISSION AND JOINING
15.1. Candidates will be admitted to the Dental Wing as per their personal appearance at the
Counseling Centre.
15.2. A candidate selected for admission shall have to deposit the following fees payable at
the time of admission.
1. Admission Fees (one-time) `. 300.00
2. Consolidated tuition fees per term (per annum) `. 6,000.00
3. Library Fees (per annum) `. 200.00
4. Journal Fees (per annum) `. 1,000.00
5. Fees for issue of Identity Card (one-time) `. 20.00
6. College caution money (one-time & refundable) `. 5,000.00
7. PG Students’ Union Fees (one-time) `. 400.00
8. Dramatic Fees (one-time) `. 200.00
9. Students; Academic Society Fees (one-time) `. 300.00
10. Red-Cross Fees `. 10.00
Total `. 13,430.00
15.3. The courses of study and the registration of candidates for PG (Dental) study will be
regulated by the Utkal University.
15.4. The Medical Fitness Certificate (Appendix No. V) must be produced by the candidate at
the time of joining.
15.5. If any candidate does not join or leaves after joining the PG (Dental) Course, the seat
can not be filled up on any account a s per Dental Council of India guidelines and the
candidate concerned shall not be considered for selection in the next three academic
sessions of the MDS Course and stipend / salary received by him / her will have to be
refunded.
16. ATTENDANCE
16.1. PG Students are to perform the duties as assigned to them by the Professor concerned
and to attend required theory and practical classes and departmental seminars regularly.
16.2. PG Students are entitled to avail 15 days leave during each year of study with the
permission of the Head of the Institution, but such leave should not exceed 10 days at a
stretch.-11-
16.3. Absence beyond the total period of 15 days without prior permission of the Head of the
Institution, shall be seriously viewed and the candidate shall forfeit the right to continue.
16.4. All candidates on joining the PG Course shall work full time during the period of training
attending not less than 80% of the training during each calendar year.
17. SALARY AND STIPEND
17.1. PG Students admitted against direct quota seats will be paid stipend at rates prescribed
by the Government of Odisha from time to time subject to satisfactory performance of
duties and maintenance of discipline and decorum.
17.2. Stipend / Salary of in-service PG Students under employment of Government of Odisha
will be governed by the existing Govt. principles or any instruction as would be issued
from time to time.
17.3. The period of PG study of In-service category of candidates under regular employment
of Government of Odisha (not on adhoc or contractual basis) admitted into PG Courses
shall be governed as per the existing service rules and executive instructions thereon.
18. HOSTEL
18.1. Hostel accommodation being limited, cannot be guaranteed for all and allotment of seats
in the Hostel will be made by the Principal of the S.C.B. Medical College, Cuttack to the
needy and deserving students according to availability of seats.
18.2. Fees to be paid for hostel accommodation:
(as per Government Resolution No. 16956 / H. dated: 08.05.2002)
1. Hostel Fees Per annum `. 1,500.00
2. Hostel Fund Per annum `. 600.00
3. Common Room Fees Per annum `. 500.00
4. Hostel Caution Money One time `. 1,000.00
(refundable)
5. Electricity and Water Charges Per annum `. 5,000.00
Total `. 8,600.00
19. MISCELLANEOUS
19.1. No correspondence of any kind will be entertained.
19.2. If any candidate discontinues PG studies in the midst of the academic session for any
reason, he/she will not be eligible to apply for PG admission for subsequent 3 (three)
academic years.
19.3. If the candidate discontinues PG studies for any reason, what so ever, at any stage after
admission, he/she shall be liable to refund the entire amount of stipend / leave salary,
pay and allowances, etc. actually paid to him/ her during the period of his / her studies.
19.4. All PG (Dental) Degree holders, who are offered jobs by the Government, but opt not to
join the same shall be liable to refund the leave salary / pay and allowances / stipends
actually paid to him/her during the period of study along with other such disciplinary
action as the Government may decide.-12-
19.5. Without prejudice to the conditions stipulated for submission o f application/ selection/
admission in the foregoing paragraphs of this prospectus, a candidate who is suffering /
has suffered from mental disease, drug addiction or has been convicted for any criminal
offence shall not be selected / admitted even though he / she may have been eligible for
selection / admission under the provision of this prospectus. Concealment /
misrepresentation about mental illness, drug addiction and criminal conviction shall be
liable for disqualification.
19.6. A selected candidate shall be required to produce all original documents and deposit the
same, if required, including the Original College leaving Certificate at the time of
counseling. He / She has to appear before a Medical Board (s) constituted for the
purpose to decide his / her Medical Fitness.
19.7. In all matters relating to eligibility or otherwise of a candidate for registration, sitting in
entrance examination, selection and admission into PG courses, the decision of
selection committee shall be final.
19.8. If any candidate does not receive his / her admit card, he / she can contact personally to
the Convenor & Principal, PG (Dental) Selection Committee – 2012, two days before the
Entrance Examination for issue of duplicate Admit Card. Such candidates are required
to submit an application along with two attested Colour / Black & White 40×50 mm size
photographs and the Acknowledgement Card.
19.9. If any candidate does not receive his/her intimation / call letter, he / she can contact
personally to the Convenor & Principal, PG (Dental) Selection Committee – 2012, two
days before the date of Counseling for issue of duplicate intimation / Call Letter.
19.10. All admissions are subject to verification of the original documents as well as production
of Medical Fitness Certificate in the form as in Appendix – V.-13-
APPENDIX – I
SERVICE CERTIFICATE
(Including the leave period)
Certified that Dr. ___________________________________________________ is now working as
________________________________________ (designation) in the Medical Institution(s) detailed
below (as per entry in service book), excluding the total period leave availed by him / her in e xcess of
one month in a year.
A. Details of Institution Served:
Name of the
Medical
Institution (s)
Block
Nature of Service
(Adhoc / Temporary /
Contractual / Regular)
Date of
Joining
Date of
Relief
B. Details of Leave Period of more than at a stretch leave of 30 days or more excluding
maternity leave.
Name of the
Medical
Institution (s)
Block
Nature of Service
(Adhoc / Temporary /
Contractual / Regular)
Date on which
proceeded on
leave
Date of
Joining
Place:
Signature of C.D.M.O. / Head of the office
Date:
(Name)
Seal-14-
APPENDIX – II
FORM NO. III
(The Odisha Miscellaneous Certificate Rules, 1984)
Office of the __________________________________________________________ Miscellaneous
Certificate Case No. ____________________________________ of _________.
RESIDENT / NATIVITY CERTIFICATE
This is to certify that Shri / Smt. / Miss _____________ ______________________________ son /
daughter / wife of Shri ___________________________________________________ is a native of
the Dist of ___________________________ in the State of Odisha and he / she / his / her family
ordinarily resides in Village / T own: ______________________________________ P.S:
______________________________ Tahasil _________________________________ in the District
of ________________ in the state of Odisha, for the period from ________________ to
_________________________.
The certificate is granted only for the purpose of
Full Signature of the Applicant Signature of the Revenue Officer
Date: ___________________ Date: _____________________
Round Seal of the Office Designation
(With Seal of the Office)
Note:
1. “Revenue Officer” means the Chief Officer -in-charge of Revenue Administration in the District,
Sub-division or Tahasil and includes an Additional District Magistrate and Additional Tahasildar.
2. No part of the form should be mutilated in any manner. In case of mutilation the candidate is
liable to be rejected.-15-
APPENDIX – III
CERTIFICATE OF DEFENCE SERVICE
(OF CANDIDATE’S PARENT / SPOUSE)
1. Full Name of Employee / Person :
2. Permanent Address as per service records :
3. Whether serving/ retired / deceased / permanently disabled / killed in war / hostilities
4. Rank in Defence Service :
5. Full Name of the Candidate :
6. Relationship of the employee / person with the candidate :
7. Present place of posting including details of unit (in case of serving personnel) :
8. Last place of posting including details of Unit (in case of retired / killed in war / hostilities /
deceased personnel)
9. Duration of defence services: Yrs (From……………………………. to………………………..)
Full Signature of Candidate’s Parent / Spouse
Date:
Full Signature
of Station Commander/Office Commanding/
Officer-in-charge/Secretary Zilla/Rajya Sainik Board
Date:
Designation
(With Office Seal)-16-
APPENDIX – IV
SPONSORSHIP CERTIFICATE
This is to certify that Dr. whose
appointing authority is and who
at present posted as (Designation) at (name of the
Place) has been
sponsored by (employing organization)
to take the course of studies leading to PG(Dental) Degree in the SCB Dental College,
Cuttack, Odisha for a period of three years subject to his/her eligibility for admission into the
course.
Place : Signature of the Appointing Authority
Date : Designation
Seal of the Office-17-
APPENDIX – V
PG (DENTAL) SELECTION – 2012, ODISHA
MEDICAL CERTIFICATE
Certified that this day I examined _________________________________
For physical fitness for M.D.S. Studies. The findings are as detailed below.
Name and Address:
_______________________________________
_______________________________________
_______________________________________
1. Height (Not less than 150 cm for male & 140 cm for female candidates) : ______ cm
2. Weight (Not less than 40 Kg) : ______ Kg
3. (a) Chest measurement (Not less than 70 cm) : ______ cm
(b) Chest expansion (Not less than 4.5 cm) : ______ cm
4. Condition of Heart (Abnormality, if any) : _________________________________
5. Conditions of Lungs (-do-) : _________________________________
6. (a) Vision : In case of defective vision it must be corrected to
6/9 in both eyes or 6/6 in the better eye. : _______________________________
(b) Colour Blindness : _______________________________
7. Hearing (whether normal, where defective it must be corrected) : _________________
8. Blood Group : _________________________________________________________
9. Hernia, Hydrocele and piles (if any, to be corrected before joining) : ________________
10. History / Symptom of Epileptic fits, if any : ____________________________________
11. History / Symptom of Mental disease, if any : __________________________________
12. Orthopaedic defects, if any : _______________________________________________
Remarks: The Candidate has fulfilled (fit) / not fulfilled (unfit) the prescribed standards as stipulated
in this form for M.D.S. studies.
Full Signature of the Candidate
Signature of Government Medical Officer
(Not below the rank of Sub-Divisional Medical Officer)
with Regn. No. & Seal
Date : ____________________ Date : ____________________
Photograph of the
candidate to be
pasted here
should be signed
by the Govt.
Medical Officer
with seal-18-
ROLL NO/CAT/RTB………………………………
APPLICATION FORM
FOR
SELECTION INTO THE
PG (DENTAL) COURSES
AT
S.C.B. DENTAL COLLEGE & HOSPITAL, CUTTACK, ODISHA – 2012
APPLIED FOR: (1) M.D.S. (In Service) – Pedodontics & Preventive Dentistry
(2) M.D.S (In Service) – Oral Pathology & Oral Microbiology
(3) M.D.S (Direct) – Oral & Maxillofacial Surgery
(Strike out whichever is not applicable; otherwise th e application shall be rejected)
CATEGORY APPLIED FOR:
NAME OF THE CANDIDATE IN FULL ____________________________________
(To be filled up by the Candidate in BLOCK LETTER)
Mobile No. …………………………….. Land Phone No. ………………………………………..
E-mail ID ……………………………………………………………………………………………
———————————————————————————————————————-
In-service Direct-19-
FORM OF APPLICATION FOR SELECTION
IN TO PG (DENTAL) COURSES
At: S.C.B. DENTAL COLLEGE & HOSPITAL, CUTTACK.
ODISHA. FOR THE ACADEMIC SESSION – 2012
1. Full Name :
2. Address of Correspondence :
PIN
3. Name of the Father:
4. Name of the Husband:
5. Permanent Address of Father / Husband:
Village Post Office
Block Police Station
District State & PIN
6. Permanent Address of the Applicant:
Village Post Office
Block Police Station
District State & PIN
7. Category:
In-Service Direct SEX
Male Female
8. Type of Service:
Odisha Govt. Central Govt. Private Sector Any Other
Paste (do not
pin) a recent
photograph of
size 40 x 50
mm duly
signed by the
applicant on
top and
attested on the
front by a
gazetted
officer with
seal
(Instruction
No. 2)-20-
9. Date of Birth:
Day Month Year
10. Date of Completion
of internship: Day Month Year
11. Total Period of Service:
Day Month Year
12. B.D.S. from which State:
13. Dental Registration:
14. High School / 10
th
Class Pass Status:
Name of the
School
District State Yr. of Passing Division
15. B.D.S. Status:
Name of the College /
Institution
District State University Yr of Passing
Native of which State
Central State (Name)-21-
16. Compulsory Rotating Housemanship / Internship Status:
Name of the College /
Hospital / Institution
State
Permanent Dental
Registration Status
Registration Number
Central
17 (A):Service Particulars
Name of the
Medical Institution
Block / NAC /
Municipality / Dist.
Date of
Joining
Date of
Relief
Duration of
Service
17 (B): Leave Particulars
(of more than 30 days at a stretch except maternity leave)
Name of the
Medical Institution
Block / NAC /
Municipality / Dist.
From To Duration
17 (C): Total service period excluding leave at a stretch of more than 30 days(except maternity leave):
Days Months Years
18. Details of Bank Draft:
Amount Bank Draft No. Date Issuing Branch
`. 1500/–22-
19. Statement of Enclosures attached with Application Form
(Enclosure to be numbered by the Candidate)
Self Attested True Copy of:
1. Certificate of Board of Secondary Education / Matriculation / 10
th
Class Pass Certificate or
equivalent
2. B.D.S. Degree Certificate
3. Compulsory Rotating Internship / Housemanship Certificate / Continuation Certificate
4. Permanent Dental Registration Certificate
5. Certificate of Parent’s service Defence/ PSU
Other documents in Original:
6. Service Certificate
7. Conduct Certificate
8. Resident / Nativity Certificate
9. Certificate of Employment of Parents / Spouse
10. College Laving Certificate.
DECLARATION
1. I declare that the above statement of particulars furnished by me in the Application and the
appendices are true in all respects and as such, I undertake that if subsequent to my admission, I
will be found to have given wrong information with regard to marks, certificates and documents
produced by me in connection with my admission then my name will be immediately removed
from the college in addition to whatever legal action that be taken against me.
2. I submit myself to the jurisdiction of the authorities of PG (Dental) Selection Committee – 2012,
Odisha and declare that I shall abide with the rules and regulations a s laid down in the P.G.
(Dental) Prospectus 2012 and that the decision of the authorities of the above mentioned
committee about my merit position will be binding and acceptable to me.
3. In the event of my being found ineligible at a later date, I understand that I will be denied the
opportunity of selection / admission will be cancelled even if am selected and admitted.
4. I agree to abide by the rules of the College and Hospital and pay all fees and deposit all other
dues as laid down by College and Hospital r ules or may become due under these rules and also
agree to withdraw myself from the College and Hospital should the Vice -Principal decide that
such withdrawal is necessary in the interest of the institution.
I hereby certify that I have completed the Appl ication Form in all respects with requisite
documents as per details given above and my application contains …………….. enclosures
excluding the Application Form.
Signature of the attesting Signature of the Applicant in full
Gazetted Officer Date ______________________
(Full name and Designation) Official Seal (In presence of the attesting officer)-23-
ADDRESS SLIP
The candidate shall fill up his / her name and correct present address for correspondence on the address
slip below (His / her Reference No. is to be filled up by the Office)
For Office Use Address for Correspondence
Reference No. :
Nature of Despatch :
Date of Despatch :
To
Reference No.
Dr.
C/o
At
P.O.
District State
PIN
Reference No. :
Nature of Despatch :
Date of Despatch :
To
Reference No.
Dr.
C/o
At
P.O.
District State
PIN
Reference No. :
Nature of Despatch :
Date of Despatch :
To
Reference No.
Dr.
C/o
At
P.O.
District State
PIN
Reference No. :
Nature of Despatch :
Date of Despatch :
To
Reference No.
Dr.
C/o
At
P.O.
District State
PIN-24-
ENTRANCE EXAMINATION FOR PG (DENTAL) SELECTION – 2012
REGISTERED POST/SPEED POST
To
_______________________________________
_______________________________ ________
_______________________________________
___________________________PIN_________
(Write your name and address on the card)
From:
Convenor & Principal,
PG (Dental) Selection Committee – 2012
S.C.B. Dental College & Hospital, Cuttack
PIN – 753 007, Odisha.
ACKNOWLEDGEMENT CARD
Your Application Form of PG (Dental) Selection has been
Received on ________________________________
You have been assigned Index No. ____________________________
Please quote this number in all corresponde nce regarding admission; otherwise your
queries will not be attended to.
Convenor & Principal,
PG (Dental) Selection Committee – 2012
S.C.B. Dental College & Hospital, Cuttack – 753 007
O D I S H A
Note: This card with your address for correspondence properly written on the reverse and duly
stamped should be sent along with the application.
Affix
Postage
Stamp
Rs. 22/–25-
ENTRANCE EXAMINATION FOR PG (DENTAL) SELECTION – 2012
ADMIT CARD
Name of the Candidate Dr. ____________________________________ ____________
(The applicant to write his / her name)
Roll No. _________________________________
Examination Centre
Time: 10.00 AM to 1.00 PM
NOTE:
1. Issue of this card does not necessarily mean acceptance
of eligibility which will be further scruti nized at subsequent
stages of selection
2. Please do not detach the Attendance Card
Convenor & Principal,
Full signature of the Candidate PG (Dental) Selection Committee – 2012
(Not in Capital Letter) S.C.B. Dental College & Hospital, Cuttack – 753 007,
O D I S H A
ENTRANCE EXAMINATION FOR PG (DENTAL) SELECTION – 2012
ATTENDANCE CARD
Name of the Candidate Dr. ________________________________________________
(The applicant to write his / her name)
Roll No. _______________________________ __
Examination Centre
Q & A Booklet No.
Hall No. Seat No.
Signature of the invigilator
Full signature of the Candidate ________________ Centre
(To be obtained at the time of Examination) Hall No. _______________
Paste (do not pin)
a recent
photograph of size
40 x 50 mm duly
assigned by the
application top and
attested on the
front by a gazetted
officer with seal
Paste (do not pin)
a recent
photograph of size
40 x 50 mm duly
assigned by the
application top and
attested on the
front by a gazetted
officer with seal-26-
(To be printed at the back of Admit Card)
INSTRUCTION TO THE CANDIDATES
1. The card must be shown to the Officer Supervising the examination. A candidate without the
valid Admit Card shall be debarred from the Entrance Examination.
2. You should report one hour befo re the commencement of examination at the Center (9.00 AM).
You must occupy your seat 30 minutes before the commencement of examination (i.e. 9. 30 AM).
3. No candidate shall be allowed to the examination hall soon after the commencement of
examination. No candidate will be allowed to leave the hall till the end of the examination.
4. The candidate must observe complete silence and shall concentrate to his/her Q & A booklet.
Violation of any instruction and adoption of any unfair means on the examination hall shall
render a candidate liable for cancellation of his/her Q & A booklet and forfeiture of his/her claim
for admission. Decision of the centre Superintendent shall be final.
5. Use blue / blue-black ball pen / fountain pen supplied at the examination centr e.
6. Detach the blank sheet supplied with the Q & A booklet for rough work before handing over the
booklet to the invigilator.
7. The candidates are not allowed to carry bits of paper / any textbook / manuscript except their
Admit Card to the Examination Hall.
8. No T.A. and D.A. will be paid appearing the entrance examination.
9. No mobile phone or any other electronic communication system will be allowed into the
examination hall.
BY REGISTRED POST/SPEED POST
To
_______________________________________
_______________________________________
_______________________________________
___________________________PIN_________
(Write your name and address on the card)
From:
Convenor & Principal,
PG (Dental) Selection Committee – 2012
S.C.B. Dental College & Hospital, Cuttack
PIN – 753 007, Odisha.
Affix
Postage
Stamp
Rs. 22/-