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•11i, '8c k8 9ttCt1 Memo No. 526/1(18)/ConfBkp. Date 25/07/2018

Copy forwarded for information and taking necessary action to:

I. The District Magistrate, North 24 Parganas, Barasat 2. The Additional District Magistrate (Dev.), North 24 Parganas, Barasat 3. The C.M.O.H., North 24 Parganas 4. The A.C.M.O.H., Barrackpore 5. The Savapati, Barrackpore- I Panchayat Samity 6. The Block Development Officer, Barrackpore — I Development Block with a request to publish the Notification in all Government Offices and all G.Ps under your jurisdiction 7. The B.M.O.H., Barrackpore — I with a request to publish the said Notification in all the Health Institutions under your jurisdiction. 8-15. Prodhan, all Gram Panchayat under Barrackpore I Development Block 16. The SDICO, Barackpore with a request to publish the said notification in local newspapers 17. The D.I.O., NIC with a request to upload the said Notification in the District Website 18. Computer Cell of Sub-Divisional Officer, Barrackpore for uploading the same in the Sub- Divisional Website.

Sub-DThnal Officer, Barrackie, North 24 Parganas APPLICATION FORM For Recruitment of Accredited Social Health Activist (ASHA) To The Chairman ASHA Selection Committee, Barrackpore Sub-division, Dist: North 24 Parganas.

Respected Sir, I, Smt. , want to work as an ASHA worker. In response to the Advertisement No. 526/Con/Bkp, Dated 25/07/2018 of the Sub-divisional Officer, Barrackpore Sub-division, I hereby submit my Bio-data below: I. NAME (in Block letters) 2. Name of Father 3. Name of Husband 4. Age (Date of Birth) 5. Category (SC/ST/OBC) 6. Marks obtained in Madhyamik Pariksha: : Total Marks: 7. Name of Health Sub-Centre applied for: 8. Present Postal Address: a) ArealLocality b) Village c) Name of Gram Panchayat d) PIN 9. Postal Address before marriage: a) ArealLocality b) Village c) Name of Gram Panchayat d) PIN Place: Dated: Phone No.: Signature of the Applicant

DECLARATION I do hereby declare that I am an aspirant for ASHA worker. I am living in the above address for the

last ( ) years. I shall be liable to punishment under law if my declaration is found false.

Signature of the Applicant RECIEPT of Application Form (ASHA-2018) Application for ASHA worker for Health Sub-Centre is received from Smt. of Village Ofl

For Block Dcv. Officer, Barrackpore-1 Dcv. Block 1cc'r'i • (r1t1 ilc'i c)

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Health Sub-Centre ASHA *

!T111f, qFg1' - PRESENT STATUS OF VACANT POSITIONS OF ASI-IA REGARDING NEW SELETIONI NEW ADVERTISEMENT NAME OF BLOCK:- BARRACKPORE-I, GRAM PANCHAYAT- PALASHI MAJIPARA

STATUS OF VACANT POSI11ON OF ASHA SL. NO. NAME OF OP. NAME OF SUB-CENTRE VILLAGE WITH IN SUB- CENTRE GENERAL SC ST OBC TOTAL

I PALASHIMAJIPARA 3,NAGDHA NAGDAHA 1 0 1 0 2 2 PALASHI MAJIPARA 3,NAGDAHA OHRIWALA 1 0 0 0 1 3 PALASI-lI MAJIPARA 2,SHYAMAPRASAD PALL'( CI-IOUGACHA 0 1 0 0 1 4 PALASI-lI MAJIPARA 1,MAJHIPARA PALASHI 1 0 0 1 2 S RALASHI MAJIPARA 2.SHYAMAPRASAD PALLY NOABJLL.A 0 0 1 0 1 6 PALASE-lI MAJIPARA 5,DHANKAL RAMKRISHNA COLONY 1 0 0 0 1

Block Medical Offlcc1 H.aIth Nanna B,PfLC Bp- 1, 24 Pgs. (N) PRESENT STATUS OF VACANT POSITIONS OF ASHA REGARDING NEW SELETION! NEW ADVERTISEMENT NAME OF BLOCK:- BARRACKPORE-I, GRAM PANCHAYAT- KAMPA CHAKLA

STATUS OF VACANT POSITION OF ASI-IA SL. NO. NAME OF CF. NAME OF SUB-CENTRE VILLAGE WITH IN SUB- CENTRE GENERAL SC ST OBC TOTAL

1 KAMPA CHAKLA SCHANDUA CF-IANDUA 1 1 0 0 2 2 KAMPACHAKLA 8.CHANDUA CI-IAKLA 2 0 0 1 3 3 KAMPA CF-IAKLA 7PALLADAHA JONEPUR & RABINDRANAGAR 2 0 0 0 2 4 KAMPA CHAKLA 7FALLADAHA PALLADAHA LAKE TOWN 2 0 0 1 3 5 KAMPACHAKLA 7PALLADAHA SANTRAPARA 1 0 0 0 1 6 KAMPACHAKLA 6KAMPAGP KAMPA 3 0 0 0 3 7 KAMPACHAKLA 6KAMPAGP CHARAPOLE 1 1 0 0 2

Block Medca ocfer f laIb Nanna B.P.1-LC.. 24 (N) PRESENT STATUS OF VACANT POSITIONS OF ASHA REGARDING NEW SELETIONI NEW ADVERTISEMENT NAME OF BLOCK:- BARRACKPORE-I GRAM PANCHAVAT- MAMUOPUR

STATUS OF VACANT POSITION OF ASHA SL. NO. NAME OF G,p. NAME OF SUB-CENTRE VILLAGE WITH IN SUB- CENTRE GENERAL SC ST OBC TOTAL

I MAMUDPUR 15,RAJENDRAPUR MADARPUR 1 0 1 0 2 2 MAMUDPUR 16BHABAGACHI BHABAGACHI 0 0 0 1 1 3 MAMUDPUR 16BHABAGACHI I-IORISHPUR 0 1 0 0 1 4 MAMUDPUR 18DOGACHIA DOGACHIA 0 0 0 1 1 5 MAMUDPUR 14BORA BORA 0 1 0 0 1 6 MAMUDPUR 19,SUBHASPALLY SUBHASHNAGAR 1 1 0 0 2 7 MAMUDPUR 17DEBAK KULIAGARH 1 1 0 0 2

Block Medicai OUor o -!etth Nanna B.P.H.C.. Fkp-J - 24 Pgs. IN) PRESENT STATUS OF VACANT POSITIONS OF ASHA REGARDING NEW SELETION! NEW ADVERTISEMENT NAME OF BLOCK:- BARRACKPORE-I, GRAM PANCHAYAT- JETIA

STATUS OF VACANT POSITION OF ASHA VILLAGE WITHIN SUB- CENTRE SL. NO. NAME OF G.P. NAME OF SUB-CENTRE GENERAL SC ST OBC TOTAL

1 1 0 1 3 1 JETIA 12. BALIBHARA BALIBHARA 0 0 0 1 1 2 JETIA 9,JETIA JETIA

BlocI; Me1 OtfIcr. oflHeiL. Nanna B.PH.C. Bkp-i. 24 Pgs. (N PRESENT STATUS OF VACANT POSITIONS OF ASHA REGARDING NEW SELETIONI NEW ADVERTISEMENT NAME OF BLOCK:- BARRACKPORE-I, GRAM PANCHAVAT- SHIBDASPUR

STATUS OF VACANT POSITION OF ASHA SL. NO. NAME OF G.P. NAME OF SUB-CENTRE VILLAGE WITHIN SUB- CENTRE GENERAL SC ST OBC TOTAL

1 SHIBDASPUR 23, MAHABATIPARA KANDAPUKUR 0 0 0 1 1 2 SHIBDASPUR 23, MAHABATIPARA BARIKPARA 1 0 0 0 1 1 SHIBDASPUR 22,SALIDAHA SALIDAHA 0 0 1 0 1 1 ' SHIODASPUR 21,SHIBDASPUR KHANARHAT 0 0 0

I3Iock Meth —I s' I Off!cr of Hat Nann B.P.H,C 24 Pgs. PRESENT STATUS OF VACANT POSITIONS OF ASHA REGARDING NEW SELETIONI NEW ADVERTISEMENT NAME OF BLOCK:- BARRACKPORE-I, GRAM PANCHAYAT- PANPUR KEWTIA

STATUS OF VACANT POSITION OF ASHA SL. NO. NAME OF G.P. NAME OF SUB-CENTRE VILLAGE WITH IN SUB- CENTRE GENERAL SC ST OBC TOTAL

1 PANPUR KEUTIA 24,BELLE PANPUR 1 0 0 0 1 2 PANPUR KEUTIA 24BELLE BELLE 0 1 0 0 1 3 PANPUR KEUTIA 25MUKUNDAOUR KASIBATI 1 1 0 0 2 PANPUR KEUTIA 26,KEUTIA KEUTIA SARKARI AMTALA 1 0 0 0 1 5 PANPUR KEUTIA 26KEUTIA KEUTIA MANTU COLONY 1 0 0 0 1 6 PANPUR KEUTIA 26,KCUTIA KEUTIAJAGADHATRITALA 1 0 0 0 1

4'\' I Block Medca1 Officer hr Heah Nanna B.P,H.C,, Bkp-1, 24 Pgs, (N) PRESENT STATUS OF VACANT POSITIONS OF ASHA REGARDING NEW SELETIONJ NEW ADVERTISEMENT NAME OF BLOCK:- BARRACKPORE-I, GRAM PANCHAYAT- KAWGACHI-I 1

STATUS OF VACANT POSITION OF ASHA SL. NO. NAME OF GP. NAME OF SUB-CENTRE VILLAGE WITH IN SUB- CENTRE GENERAL SC ST OBC TOTAL

I KAWGACHI-I 34TARUN SANGHA CLUB ADIBASHIPARA 1 0 0 0 1 2 KAWGACHI-I 34TARUN SANGHA CLUB RAMKRISHNAPALLY 1 0 0 0 1 OKNGAR KNUDIRAM 3 KAWGACHI-I 32,KHUDIRAM NAGAR 1 0 0 0 1

4 KAWGACHI-I 33,VIVEKANADAGARH VIVEKANADAGARH 0 0 0 1 1 5 KAWGACHI-I 28KOWGACHI-1GP KOWGACHI NIMTALA 1 1 0 0 2

Block Mej1iCal Otcr ol eIUI Nna B.P.H-C. l3kp-l. 24 PgS U•) PRESENT STATUS OF VACANT POSITIONS OF ASHA REGARDING NEW SELETIONI NEW ADVERTISEMENT NAME OF BLOCK:- BARRACKPORE-I, GRAM PANCHAYAT- KAWGACHI-II

STATUS OF VACANT POSITION OF ASHA SL. NO. NAME OF G.P. NAME OF SUB-CENTRE VILLAGE WITH IN SUB- CENTRE GENERAL SC ST OBC TOTAL

59 KAWGACHJ-II 30KOUGACHI-II GP DAKHIN HANSIA 1 0 0 0 1 60 KAWGACHI-II 30KOUGACHI-II GP DASPARA 0 1 0 0 1 65 KAWGACHI-II 27BASUDEVPUR BASUDEBPUR 0 0 0 1 1

Block M&jca Ofiic.r of ldahh Nanna B.PH.C., kp-i, 24 Pgs. N)