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MO, SN, FHW Training Registration Form

The document is a registration form for a SKILL LAB Training Program for Medical Officers, Staff Nurses, and Female Health Workers at the Divisional Training Centre in Aliabada, Jamnagar. It requires participants to provide personal details, educational qualifications, work experience, and banking information. The form must be filled out in capital block letters.

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omshreegraphics8
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101 views1 page

MO, SN, FHW Training Registration Form

The document is a registration form for a SKILL LAB Training Program for Medical Officers, Staff Nurses, and Female Health Workers at the Divisional Training Centre in Aliabada, Jamnagar. It requires participants to provide personal details, educational qualifications, work experience, and banking information. The form must be filled out in capital block letters.

Uploaded by

omshreegraphics8
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Divisional Training Centre, Aliabada Dist.

Jamnagar
SKILL LAB Training Program for MO, SN, FHW
Registration Form
(Fill in Capital Block Letters)

1. Name :-__________________________________________________
2. Date of Birth :- _________________________________________________
3. TMIS ID :- _________________________________________________
4. Designation :- _________________________________________________
5. Office Address :- PHC/CHC/UHC/GH___________________________________

Taluka__________________District ____________________

6. Numbers :- [Link] __________________ Mobile _______________


7. Educational Qualification :- _____________________________________________
_______________________________________________
8. Work Experience :- _______________________________________________
______________________________________________
9. Date & Time of Arrival :- ________________________________________________
10. Date & Time of Departure :- _____________________________________________
11. Adhar No :-_________________________________________________
12. Account No :-_________________________________________________
13. Bank Name :-_________________________________________________
14. IFSC CODE :-_________________________________________________

Signature

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