Public Service Commission U.P.
, PRAYAGRAJ
लोक सेवा आयोग उ0प्र0, प्रयागराज
Detailed Application Form ( विस्तृत आवेदन पत्र )
Notification Details ( Examination )
Advertisement Number : A-3/E-1/2023
Department/Directorate Name : MEDICAL EDUCATION AND TRANING DEPTT.
Applied for Post : STAFF NURSE (FEMALE),
Type of Recruitment : GENERAL RECTT.
Candidate's Personal Details
OTR Number : 858438895525 Application ID : 009145726000294
Candidate's Name : NIKKI KUMARI Father's/Husband's Name : HARI SIMGH
Mother's Name : GAYATRI DEVI Gender : Female
Date of Birth : 28/08/1996 Domicile of UP : Yes
Home State : UTTAR PRADESH Home District : MATHURA
Category : SC Marital Status : Single
Mobile Number : XXX-XXX-3349 Email-ID : ****
[email protected]Bank Transaction Details
Payment Gateway : State Bank Of India Payment Mode : INB
Fee Amount : Rs. 65.00 Transaction ID - Date: CPADBPIIB2 - 10/09/2023
Candidate's Other Details :
Are you Dependent of UP
No Are You Skilled Player of UP? : No
Freedom Fighter?
Are You Extra Ordinary Player
No Level of Player : ---
of UP?
Service Duration (Day-Month-
Are you UP Ex. Army? No 0-0-0
Year) :
Retirement Are you ECO/SSCO/CO of
--- No
Date(Date/Month/Year) : Army ?
Have your services been
Have you completed 5 year extended for rehabilitation and
No No
service ? no disciplinary action is
pending against you ?
Are You Physically
A). Are you Blind or Have
Handicapped (Divyangjan) of No No
Vision problem? :
Uttar Pradesh?
C). Have you any Physical
B). Are you Deaf or Have
No Problem (Locomoter disability No
hearing problem? :
or Cerebral Palsy)? :
D). Have you any Neurological
E). Have you Multiple Disabilities? : No
Problem? : No
Are You State Govt. Employee Service Duration (Day-Month-
No 0-0-0
of Uttar Pradesh ? : Year) :
Have you ever been Debarred Completion Date of Debarment
No N/A
from UPPSC ?: (DD/MM/YYYY) :
Basic Academic Qualification Details :
S No Examination Passed Board Name Year Of Passing Roll Number
UTTAR PRADESH BOARD OF HIGH SCHOOL AND
1. High School 2012 0259780
INTERMEDIATE EDUCATION
Essential Qualification Details
Evalation Type
Year Of Passing
Obtained Marks
Sr. No. Qualification AffirmationUniversity/Institute Cert/Roll Number
Total Mark
Issue Date
Percentage
1-Have passed High School
Examination with Science and
passed Intermediate
Examination of the Board of
High School and Intermediate
Education, Uttar Pradesh or an
Examination recognised by the
N/A
Government as equivalent
N/A
1. thereto 2-Possess diploma in Yes ---
N/A
General Nursing and Midwifery N/A
N/A
or B.Sc Degree in Nursing
registrable with the U.P. Nurses
and Midwives Council 3-Possess
registration certificate as Nurse
and Midwife from the Uttar
Pradesh Nurses and Midwives
Council
Candidate's Registration as Nurse & Midwife and Experience Details worked as on Contract basis ↓
Possess Registration Certificate as Nurse and Midwife from the Registration Number : 110644
Yes
Uttar Pradesh Nurses and Midwives Council : Registration Date [DD/MM/YYYY] : 22/03/2022
Working as Staff Nurse on contract basis in the Medical and
Total Experience as Nurse on Contract basis as on last date of
Health Services Department, Uttar Pradesh /Medical Education No -/-/-
Application Form Submission [Year-Month-Day] :
and Training Department, Uttar Pradesh :
Candidate's Permanent & Communication Address Details :
Permanent Address Correspondence/Mailing Address
HARI SINGHVILL BHARNA HARI SINGHVILL BHARNA
Address (Line 1 2 3) : Address (Line 1 2 3) :
KHURDPOST BHARNA KALAN KHURDPOST BHARNA KALAN
House No. : NA House No. : NA
Street No./PO : NA Street No./PO : NA
City Name : MATHURA City Name : MATHURA
State : UTTAR PRADESH State : UTTAR PRADESH
District Name : MATHURA District Name : MATHURA
PIN : 281502 PIN : 281502
I accept the following declaration : :Yes
1. I hereby declare that I have read all terms & conditions according to the advertisement and I accept it.
2. I hereby declare that all the entries/statements made in this application are true, complete and correct to the best of my knowledge and belief.
3. I under take that if any information furnished or documents submitted by me are found to be false or have been concealed, then my application/candidature is liable to
be rejected/cancelled by UPPSC.
Accepted : Application form has been Provisionally accepted. -
Application Form Submission Date : 10/09/2023 , Time : 06:57:22 Application Form printing Date & Time : [ 10/09/2023 ,06:57:25 ]
