District Health and Family Welfare Samiti, Hooghly DRS Campus, 1 floor, Barabazar, Chinsurah, : Hooghly-712101 (033) 2680-1193/4858; Fax: (033) 2680 1193 E-mail: [email protected]/[email protected]

Memo No: 464 Dated: 13 .08.2021

ORDER

Mr./Miss/ Mrs Sk Aziz Ahmed,(OBC-A Category) residing at Vill: Baratajpur, P.0.-Baratajpur,P.S.-,

Sub division: Dist.- , Hooghly, PIN-712306 is hereby engaged as Block ASHA Facilitator (Block Programme Coordinator) for Jangipara Block under District Health & Family welfare Samiti, Hooghly. All terms and conditions are same like other contractual emplyess under purview of order issued time to time by state Health & Family Welfare Samiti Swasthya Bhavan Kolkata -91. S/he will receive a consolidated monthly remuneration of Rs 15000/- (Rupees Fifteen Thousands only) S/he is being instructed to report to Block Medical Officer of Health (BMOH), Jangipara Block, within 15 days from the date of issuance of this order along with a medical certificate from a registered Medical Practitioner (holding MBBS degree) in the proforma

enclosed herewith at the time of joining in the post. The service may be terminated by one month's notice from either side.This order of engagement will stand

cancelled if the candidate fails to join within the stipulated period.

Member Secretary, District Health & Family wefare Samiti, Enclose: Proforma for Medical Cirtificate Hooghly Memo No:...6I4...M.).. Date:...... e*************** ..3a8.2.a.2... Copy forwarded for information & NA please:

i) The SDO Serampore Sub Division,Hooghly ii) The Dy. CMOH II, Hooghly/ The DPHNO, Hooghly iii) The Account Officer, Hooghly iv) The BDO, Jangipara Block, Hooghly v) The BMOH Jangipara Block, Hooghly vi) The Coordinator & Sr.Programme State Nodal Officer of ASHA Salt Lake Bhavan, Kolkata 700 091 Programme, City, Swasthya vii) Mr./Miss/ Mrs Sk Aziz Ahmed,(OBC-A Category) is hereby requested to report for to the joining the post immediately Block Medical officer of Health (BMOH), Block from the date of issuance of this order. Jangipara within 15(fifteen) days

Member138hA Secretary, District & Health Family wefare Samiti, Hooghly Medical Certificate in case of appointment of candidates under West Bengal State Health &Family Welfare Samiti

Nome ol Ihe condidate in tull fin block letlers) Heighi (without shoe) Cm Weighl Kg

nereby certily that i hovc examincd Sri/Smt..******"*******"* ****r******* **** ********..*...... i.i...... , O Lonaidoie for employnient in Ihe Wes! Bengal State Health & Fornily wellare Sarniti. cnd can' dscover o Sri/SImt ********"*******"* ** *****.********* ***s***************.****t. . hos any diseose. communicable olherwise) constilutiongl weakness or bodily infirmity.

excep. **** *** ****'*'**'**''''**' do not considcr this a disqualification lor employmen! in he office of Stotc Somiti Sr /St s cige is. according 1o his ovwn stotement...'*** ****** Yeors. ond by,oppeorance abou1... .*.*.* ...... Yeors.

General Development Good/Fair/Average/Poor

Vision Righl eye: Left eye: Uncorected/Naked eye R. Correcled Noture and degree

Teeth . Hearing. . Blood pressure

Lung Heart Liver

Spleen

Hernio (present or obsent)

Hydroeceies (present or absen

.Urirne Specitic Gravity . Albumin ii. Sugor

m. identificotion morks

The Condicate is

Paye of Unit on account ol

üi. Temporarily unfit on account of

Doted Sianature of the Medical Practitioner

Nome

Degree

Regn. No. (Seal)

Signature ol Condidate

****-** ****************** *** Attested