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    Gujarat Medical Education and Research Society, "O"-Blok, 4 Floor, Civil Hospital Campus, Opp. Pathikashram, Sector - 12 Gandhinagar-382012

    Uploaded by

    Rutul Gandhi
    1) This document is an application form for faculty positions at GMERS Medical College. It requests information such as name, address, date of birth, educational qualifications, teaching experience, research publications, and medical council registration. 2) The applicant must provide details of their MBBS/BDS degree, PG degree if applicable, teaching experience, research publications, and medical council registration numbers. 3) Supporting documents such as degree certificates, mark sheets, experience certificates, research publications, and registration certificates must be attached with the application form.

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    Gujarat Medical Education and Research Society, "O"-Blok, 4 Floor, Civil Hospital Campus, Opp. Pathikashram, Sector - 12 Gandhinagar-382012

    Uploaded by

    Rutul Gandhi
    41 views2 pages
    1) This document is an application form for faculty positions at GMERS Medical College. It requests information such as name, address, date of birth, educational qualifications, teaching experience, research publications, and medical council registration. 2) The applicant must provide details of their MBBS/BDS degree, PG degree if applicable, teaching experience, research publications, and medical council registration numbers. 3) Supporting documents such as degree certificates, mark sheets, experience certificates, research publications, and registration certificates must be attached with the application form.

    Original Description:

    App gorm

    Original Title

    application_form_13032020.pdf

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    1) This document is an application form for faculty positions at GMERS Medical College. It requests information such as name, address, date of birth, educational qualifications, teaching experience, research publications, and medical council registration. 2) The applicant must provide details of their MBBS/BDS degree, PG degree if applicable, teaching experience, research publications, and medical council registration numbers. 3) Supporting documents such as degree certificates, mark sheets, experience certificates, research publications, and registration certificates must be attached with the application form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    41 views2 pages

    Gujarat Medical Education and Research Society, "O"-Blok, 4 Floor, Civil Hospital Campus, Opp. Pathikashram, Sector - 12 Gandhinagar-382012

    Uploaded by

    Rutul Gandhi
    1) This document is an application form for faculty positions at GMERS Medical College. It requests information such as name, address, date of birth, educational qualifications, teaching experience, research publications, and medical council registration. 2) The applicant must provide details of their MBBS/BDS degree, PG degree if applicable, teaching experience, research publications, and medical council registration numbers. 3) Supporting documents such as degree certificates, mark sheets, experience certificates, research publications, and registration certificates must be attached with the application form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    GUJARAT MEDICAL EDUCATION AND RESEARCH SOCIETY,

    “O”- Blok, 4thFloor, Civil Hospital Campus, Opp. Pathikashram, Sector- 12


    Gandhinagar-382012
    Affix Passport
    Size Photograph
    here.

    APPLICATION FORM

    For the post of Professor/Associate Professor/Assistant Professor for 11-month


    Contractual Fix pay appointment
    at GMERS Medical College, ………………………………

    1. Post Applied for in (Subject):

    2. Name of Candidate in full:


    &Address
    (In BLOCK LETTERS)
    TelephoneNo.withcode: (Phone) (Mobile)
    Email ID:

    3. Date of Birth : Age:- ……(Yr) ……..(Month)


    4. Sex : Male/ Female
    5. Present Job : Govt. / Others______ If Govt.: Regular/ Ad-Hoc
    6. Whether CCC+Exam Passed? Yes/ No
    7. Educational Qualification :

    Sr. Year of Total For Office


    Examination University Percentage Attempt
    No. Passing Marks use(Score)
    FINALMBBS/ BDS
    1 (part II only)

    2 MD/ MS/ MDS

    8. Details of Teaching Experience:

    Sr. Dates Total Period For


    Name of Institution
    No. Teaching Post Held From To Years Months Office
    use
    (Score)

    Total Teaching Experience-


    9. Details of Research Publications:
    Sr. State/ Nameof Date of Name of For
    No. National / Article Publication / Index Office
    Name of
    International ( attach list acceptance Whether use
    Journal
    Journal separately) for Journal is (Score)
    publication Indexed
    certify
    1 2 3 4 5 6 7

    10. Details of Medical /Dental Council Registration:


    Registration No. MBBS/BDS & P.G.
    Date of Registration: MBBS/BDS & P.G.
    Name of Council: Graduation & P.G.

    11. Name of two referees. (With Phone No.) 1. _______________________________


    2. _______________________________

    12. Check List of Enclosures (attested photocopies- in following order)

    (1) FINAL MBBS/BDS Mark please (6) MS/MD/MDS/D.M./M.Ch.- please


    Sheet. tick(√) GMC/GDC Registration Certificate. tick(√)

    (2) FINAL MBBS/BDS Attempt (7) MBBS Degree/ PG Certificate


    Certificate.
    (3)P.G.MARKSHEET (8)Teaching Experience Certificate
    (4)P.G. Attempt Certificate. (9)School-Leaving certificate/
    Birth Date Certificate
    (5) MBBS/BDS; GMC/GDC (10) Research Publication (original
    Registration Certificate. copy and photocopy) with a
    proof of Indexation.

    Undertaking
    I declare that information stated above are true certificate, complete to the best of
    my knowledge. If above Information is found to be false; I am bound to obey the decision
    of Selection Committee of GMERSociety, Gandhinagar.

    Place:
    Date:- Signature of Applicant

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