Government of OfficeoftheChiefMedicalOfficerofHealth ShyaHffayedEa§gLP!iifeaLBa±d±amaE

I)ated:-29/01/2019 Me mo No:-Estt./Gr.' D'/Appt/235

OR DER

AsperrecormendationofthewestBengalGroupDRecruitmentBoardandinpursuanceofMemo No.HAD/12M-01-19/A34(S8)Dated03-01-2019issuedbytheDHS,WBthefollowingcandidates(102)as mentionedinthecolumnno:111areheretyappointedtemporarilyasGDA(GeneralDutyAttendanointhe PayBandscaleofRs.4900-16200/-ofPB-IwithGradePayofRs.1700/-underWBS(ROPA)Rules2009 plus usual allowances as admissible under Government Orders issued from time to time and posted at the hospital/institutionmentionedagainsttheirnanesinthecolumnno:VIIasperANNEXURE-I(PageNo.I-7) in the existing vacancies.

0ThecandidatesareherebydirectedtodowhoadtheappointmentletterandthePVRfomatfromthe a:P#eerns¥gr::?i{tekeom=:;::#=:=!:Ei::=;£M%dHre|°drterth::S:i:;:s;::fe:e£¥hctirsethaeurthp°,:ctye`oef postingismentioned,within30daysofissuanceofthisol.der,failingofwhichhisthercandidature will be cancelled without any further correspondence. 2) All the candidates have been declared medically fit and the original copy of the medical fitness certificatesare'keptwiththisofficeandtheconcemedACMOH/SuperintendentlBMOHarehereby directedtoarrangeforcollectionfromtheofficeoftheundersignedforfutureofficerecord. 3) TheI.LL-qup`/lll|L.i`/u.Li appointments are ------made provisionalr-- shoject to satisfactory•___I Police ___:_.+ verification ^..,^.a I;omorof antecedents Cif.n/ire quvR).IncaseofanyadversePoliceVerific-ationReporireceivedagainstanyone.histherService will be terminated forthwith without any further notice. TheyareliabletobetransferredanywherewithinwestBengalintheinterestofpuolicservice. Theappointmentsaeprovisionalandliabletobeterminatedononemonth'snoticeoronemonth's

salaryinlieuofonemonth'snoticefromeitherside.>ala+, \\\ ,\\,\+ \,+ \ ,..- `` .----- _ -___ _ ~ ...... I_I______``JDo I)mlaE-ar`A 6) All the service condition s of Gr. `D' category of staff will be applicable as per WBS Rules and subsequentorders/amendmentsissuedfromtimetotime. 7)TwocopiesdulyfilledPVRFormistobesubmittedbytherespectivecandidatestotheofficeofthe concerned authority at the time of joining. 8) No T.A. & D.A. is admissible forjoining. 9) All concerned are hereby informed. I--, Chief Medical Officer of Health Purba N + rfuL

L-_ o' I,9 of Health o`. ru^++idrpurba Bardhaman MemoNo:-Estt.'/Gr.'D'/Appt/235/1(3) Dated:-29/01/2019 CoDv forwanded for information

1. The D.H.S, Swasthya Bhawan, 29, GN-Block, See - V, Salt Lake City, Kolkata - 700091. 2. The Addl. Director of Health services, Swa8thya Bhawan , 29, GN-Block, Sec -V, Salt Lake city, Kolkata - 700091. 3. The System Coordinator, I.T. Cell, Dept. of Health & Family Welfare Dept., Swasthya Bhawan, Kol-9 With respect to upload the order in the Departmental web8ite.

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= i Verification Roll

I. Naine in Full (In block capitals) with aliases, Surname Name if any. (Please indicate if you have added or dropped, at any stage, any part of your name or sumane).

2. The name of the post and service applied for

3. Present address in full (i.e. village, thana and district or house number, lane/street aTid road, PIN)

4. (a) Home address in full (i,e. village, thana and district or house number, lane/street and road, PIN)

(b) If originally a resident ofpckistan, Bangladesh, Nepal or ally other country, the address in that dominion ofmianlion to Indian Union,

5. Particulars of places where you have resided for more than one year during the preceding five years

From To Residential address in full (i.e. village, tbana and district or house liumber, lane/street and road. P[N)

I

6+ (a) Father's name in full with aliases, if any ,.. (a)

(b) Present Postal address (if dead, give the last address) . .. (b)

(c) Permanent home address .. , (c)

(d) Profession ,... (d)

(e) If in service, give designation and official address .,. (e)

7. (i) Nationality of-

(a) Father . . . (a)

(b) Mother . . . (b)

(c) Husband . . . (c)

(d) Wife . . . (d) 8. (a) Exact date of birth . . . (a) [To be supported by Birth Registration Cellificate/AdmitCardofWestBengal BonrdofSecondaryEducatiort/anyotherrecognized Bond]

(b) present age

(c) Age of Matriculation/School Final

9. (a) Place of birth, district and State in . . . (a) which is situated

(b) District and State to which you belong . . .(b)

I 0. (a) State your religion

a) Are you member of scheduled caste/ Scheduled tribe/ OBC. Answer "Yes" or "No.' and if the answer is "Yes" state the nalrie thereof. [Copy of certificate to be attached]

11.Educationqualificationsshowingplaceofeducationwithyearinschcolcolleges:

Name orscl]ooVcollcees with fl 11 dd 1'., 0 eavlllE Examii)atio n passed

12. If you have at any time been employed give details

DesignatioD of tl]e postI)e[dordescriptiol.ofwork Period Full address oT tl]e once, firlri oi. instifutioD and reasot]s for lcavil)gI)reyiou s serv]ce

I3.HaveyoueverbeenconvictedbyaCourtofany offence or charge-sheeted by the police in connection with any criminal proceeding? lf so, the full particular of the case should be given.

14. Name of two responsible persons of your locality (I)

or two referees to whom you ae known (2) 3

Icerlifythattheforegoinginformationiscorreelandcomplctetothebestofmyknowledgeandbelief.I am liot aware of ny circumstances, which might impair my fulmess for emi)Ioyment under Goverrment. I

undersundthatsubmissionoffalseiliformationwillmakemeineligibleforemployment.

Dan...... Signatureofthecendidate

Place,."..

(Certificatctobesignedbyagazettedofficer)

Certified that I have kiiown Shri/Shimati son/drughter of She for the last ...... „ years ...... morfu and that to the best of my knowledge alid belief the particulars furnished by hjiwher ac conect.

Place..."..". Signature Date...... Designation status and address

SignarureanddesignationofthelssuingOfficerand

the name of the office with full address and date.