APPLICATION FORM FOR EMPLOYMENT IN ECHS

1. 2. (c) (f) Post applied for______________________________________________________________________________ Name of Polyclinics applied for (a) _____________________________________ (b) ________________________ ________________________ _______________________ (a) (d) (g) _______________________ _______________________ (e) (h) ___________________ ____________________

Name _____________________________(If Ex-Servicemen, write Service No______________________

Rank __________________ Arms/Services _________________ Unit last served __________________________ _____________ and date of retirement _________________ 1. 2. 3. 4. S/o/D/o/W/o _________________________ Date of Birth _______ and age _____years_______ months Sex : Male/Female ________________

Affixpassport sizephotograph

Postal Address _________________________________

_______________________________________________________________ ___________________ Pin _______________(Proof of address to be attached) Mobile ______________ Land Line ______________ Email ________________ 5. Education Qualification & Additional (Photocopies duly attested to be attached) Ser No Qualifications/ Degree 10th 12th Graduation Post Graduation Diploma/ PG Diploma Year of Passing Place and name of School/College/ Institute/University/ Board No of Attempts % Mark

(a) (b) (c) (d) (e)

6.

Work Experience. (Experience Certificate must be attached for consideration of experience. Ser No Place of work/ Name of institute/ and designation/ Appointment held Period of Employment Experience cert attached(Yes/No) Reason for leaving to Job

(a) (b) (c) (d) (e) 7. Registration No and date of registration with Indian/State Medical Council_____________________ __________________.Photocopy of registration to be attached : Yes/No 8. Honours and Awards (Professional & Service) __________________________________________

9. Details of previous service in Defence/Centre/State Govt/CGHS/ESI(Photocopies of ESM I-Card, Release Order & PPO duly attested to be attached. 10. 11. Total period of service(including SSC if any) ____________________________________________ Details of previous service if any with ECHS and reason for termination _______________________ DECLARATION (a) I hereby solemnly declare that all the statement made in the above application are true and correct to the best of my knowledge and belief. (b) I fully understand that in the event of any information furnished by me above being found fa or incorrect, action can be taken against me. Signature _______________________ Place : __________________ Date : / /2013 Name __________________________

EX-SERVICEMEN CONTRIBUTORY HELATH SCHEME (ECHS)

Ser No 1. Medical Appointment Basic Qualification MD/MS in Specialty concerned -doMBBS Work Experience Reservation for ExServicemen 60% Contractual fee per month(Rupees) 55,000/-

2. 3.

Gynecologist Medical Officer

4.

OIC ECHS Polyclinic

Graduate

Minimum Three Years in the Specialty after Post Graduation -doMinimum three Years Experience After Internship Minimum Five Years Work Exp in Health Care Institutions or Managerial Positions Minimum Three Years Work Exp Minimum Five Years Exp in Dental Lab

60% 60%

55,000/46,000/-

5. 6.

Dental Officer Dental Technician

BDS Diploma Holder in Dental Laboratory Technology Diploma Holder in Dental Hygienist/ Class-I DH/DORA DMLT/Class-I Lab Tech Course DMN, Dip/Class I NAC(Armed Forces) Diploma In Pharmacy Diploma Diploma Graduate/Class-I Clerk Trade(Armed Forces) Literate Edn-8, Class-I Driver MT(Armed Forces) Poses a civil driving license(LMV) Education ClassB GD Grade(Armed Forces) Literate

100% (Post reserved for Retired Defence Officers) 60% 70%

46,000/-

46,000/8,000/-

7.

Dental Hygienist/Assistant

Minimum Five Years Exp in Dental Lab

70%

15,0000/15,000/-

8. 9.

Laboratory Assistant Nursing Asst

Minimum Five Years Experience in Lab Minimum Five Years Experience Minimum Five Years Experience in Pharmacy Minimum Five Years Experience Minimum Five Years Experience Minimum Five Years Experience

70% 70%

15,000/15,000/-

10. 11. 12. 13.

Pharmacist Physiotherapist Radiographer Receptionist

70% 70% 70% 70%

8,000/15,000/15,000/12,000/-

14. 15.

Female Attendant Driver

Minimum Five Years Experience Minimum Five Years Experience

70% 70%

NREG Rate 10,500/-

16.

Peon

Minimum Five Years Experience

70%

NREG Rate

17.

Safai Wala

Minimum Five Years Experience

70%

NREG Rate

GENERAL INSTRUCTIONS 1. 14. Age Candidates should not have completed 63 62 years of age for Ser No 1 to 5 and 53 52 years of age for Ser No 6 to

The contractual employment will be for a period of one year subject to 2. Contractual Terms & Conditions review of their conduct and performance during the employment. The contractual employees will not be entitled any allowance, financial benefits or concessions as admissible to Govt employees. 3. Working HoursThe working hours for staff(less Ser 1 & 2) would be 48 hours per week(8x6) from Monday to Saturday, Sunday being a holiday. For specialists (Medical specialist & Gynecologist) the working hours would be 30 hours per week(5x6) from Monday to Saturday, Sunday being a holiday. The staff will be entitled to ten days leave besides Sundays and Gazetted holiday during the 4. Leave contractual period of twelve months.