IMS BHU : POST DOCTORAL CERTIFICATE COURSES ( linked with Senior Residency ) for the session July 2012 in the following super speciality of Anaesthesiology

IMS BHU : POST DOCTORAL CERTIFICATE COURSES ( linked with Senior Residency ) for the session July 2012 in the following super speciality of Anaesthesiology

INSTITUTE OF MEDICAL SCIENCES
BANARAS HINDU UNIVERSITY
VARANASI – 221 005

One year POST DOCTORAL CERTIFICATE COURSES ( linked with Senior Residency ) for the session July 2012 in the following super speciality of Anaesthesiology.

• Intensive Care
• Pain & Palliative Care
• Neuro Surgical Anaesthesia
• Cardiothoracic Surgical Anaesthesia
• Paediatic & Neonatal Surgical Anaesthesia

In the pay scale of Rs.25350 + NPA + other allowances as per university rules. The application must be sent by Registered/Speed post to the Head, Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi – 221 005 on or before 9th June 2012. Appearing batch can apply and may come with marksheet and certificate at the time of Written examination cum counseling which will be held on 25th of June 2012.

IMPORTANT DATES

Last date for submission of Application Form : 9th June 2012
Date of Written Examination and Counseling : 25th June 2012
Date of commencement of course : 1st July 2012

PROFESSOR & HEAD

INSTITUTE OF MEDICAL SCIENCES, BANARAS HINDU UNIVERSITY
VARANASI – 221 005
Post Doctoral Entrance Examination – July 2011 Session
APPLICATION FORM

Community : SC ST Others

Category : Sponsored Foreign Neither of these

Full Name of applicant (in CAPITAL Letters)

Father’s/Husband’s Name (in CAPITAL Letters)

Sex : Male Female Nationality : Indian Others

Date of Birth : Date Month Year

Academic Qualification (Commencing with the High School or an equivalent examination)
Examination/Degree Subject/ Specialization Year Division %/ Marks/ Grade No. of Attempts subject wise University/ College/ Board Distinction/ Scholarship

Medical Registration No.
(a) Permanent (b) Provisional (c) Date of Registration
D D M M Y Y Y Y

NAME AND FULL MAILING ADDRESS (in BLOCK LETTERS) SIGNATURE OF THE CANDIDATE
Name _______________________________________
Address ______________________________________
______________________________________
PIN CODE

UNDERTAKING : I solemnly affirm that the information furnished herein is correct in this form. I have not concealed any information. I realize that if any information furnished herein is found to be incorrect or falsification then forgo my claim to the admission/appointment in the Institute.

Date : Signature of the Candidate

Address
(a) Permanent Address (b) Local Contact Address

Contact Tel. No. with STD Code Contact Tel No. with STD code
Mobile No. : Mobile No. :
E.mail E.mail

Details of Experience/Employment/Specialized Training/Senior/Junior Residency/ Demonstratorship/Fellowship after Graduation/Post Graduation
Name of the
Hospital/Institution Position Held Period Nature of duties
From To

To be filled in only by Sponsored Candidate

(i) This Institute/Organization has No Objection in appearing of Dr./Mr./Ms. __________________ ___________________ for the above mentioned Entrance Examination. In case selected candidate will be sponsored by the Institute/Organization (Enclosed a certificate of sponsorship from the Institute/Organization)

Signature & Seal of forwarding authority

(ii) Source of funding __________________ Duration ________________ Amount __________

To be completed and signed by the Candidate

DECLARATION

I hereby declare that the information furnished by me in the Application Form is correct and nothing has been concealed. In case any information furnished by me is found to be false, my candidature/registration/admission may be cancelled/terminated. I have not concealed any information. I realize that if any information furnished herein & found to be incorrect or untrue. I shall be liable to civil/criminal prosecution and also forgo my claim to the admission/appointment in the Institute.

**I have informed my employee/HOD in writing that I am applying for this examination. I undertake that in the event of any communication from my Institute/Office/Department withholding permission to my appearing in the above Entrance Examination/admission to the course, my candidature/registration/admission may be cancelled/terminated.

Date __________________ Signature & Seal of attesting authority Signature of the Candidate

Place __________________
** To be deleted if the candidate is not employed