Indian Pharmacopoeia Commission Pharmacovigilance Associate Job 2019

Page 1

APPLICATION FORM 1.

Name of the Post Applied for: …………………………………………………….

2.

Full Name of the Candidate: ………………………………………………………

3.

(in Capitals)

Paste your recent passport size photograph

………………………………………………………………................

Date of Birth:

4.

Day Month Gender: (Write ‘1’ for Male, ‘2’ for Female)

Year

5.

Marital Status: ……………………………………..

6.

Father’s/Husband’s Name: ……………………………………………………………………………

7.

Mailing Address (in block letters): ……………………………………………………………………. ………………………………………………………………………………………………………….. …………………………………………………………………….. Pin Code: ………………………. Tel. No. : ……………………………………………… Mobile: ……………………………................ E.mail ID (if any): ……………………………………………………………………………................

8.

Nationality: ……………………………………..

9.

Whether Physical Handicapped? : (Write ‘1’ for Yes, ‘2’ for No)

10.

Category (please tick √ )

11.

All Educational/other professional Qualifications/Training Courses etc from 10th Standard Board Examination onwards:

Level Exam passed/ Division/Grade Degree Trg. % of Marks

SC

Year of Passing

ST

Duration of the Degree/ Diploma

OBC

GENERAL

Board/ University

Subject

Subject of Specialistion


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