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The document is a combined application form for various posts under the Directorate of Medical Education and Health Services in Assam, filled by candidate Devabrat Gogoi. It includes personal details such as contact information, educational background, and employment exchange registration. The candidate is applying for Non-Technical Posts and belongs to the OBC/MOBC category.

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21 views2 pages

Report

The document is a combined application form for various posts under the Directorate of Medical Education and Health Services in Assam, filled by candidate Devabrat Gogoi. It includes personal details such as contact information, educational background, and employment exchange registration. The candidate is applying for Non-Technical Posts and belongs to the OBC/MOBC category.

Uploaded by

gdebabrat88
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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GOVERNMENT OF ASSAM

COMBINED APPLICATION FORM FOR FILLING UP POSTS UNDER


DIRECTORATE OF MEDICAL EDUCATION, DIRECTORATE OF HEALTH SERVICES, DIRECTORATE OF HEALTH SERVICES (F/W) ASSAM

Personal Details:
Application No. : 2410051878
Full Name of the Candidate DEVABRAT GOGOI
:
( As per Aadhaar Card/ Pan Card/ Passport )
Candidate's Father's Name : BHABEN GOGOI
Candidate's Mother's Name : JUN GOGOI
Candidate's Spouse Name :
Candidate's Date of Birth (DD/MM/YYYY) : 20/03/2004
Gender : MALE
Correspondence Address : NO 2 UTTARKATHANI
: DHALPUR
: LAKHIMPUR
City : LAKHIMPUR
District : LAKHIMPUR
State : ASSAM
Pin Code : 784165
Permanent Address : NO 2 UTTARKATHANI
: DHALPUR
: LAKHIMPUR
City : LAKHIMPUR
District : LAKHIMPUR
State : ASSAM
Pin Code : 784165
Mobile No. of the Candidate : 6001254864
Alternative Contact No. Telephone / Mobile : 9957477379
E-mail Address of the Candidate : [email protected]
Nationality of the Candidate : INDIAN
Physical identification Marks : Small mall in face
Category of the Candidate : OBC/MOBC(NCL)
Sub categories under OBC/MOBC Category : OTHERS
Do you belong to Physically challenged/Divyang?) : NO
Whether Candidate is Permanent Resident of Assam ? : YES
Employment Exchange Registration No. of Assam : : 1278469/04/2022

Do you want to apply for Non - Technical Posts : YES


GRADE - III Non Technical Posts : (Group-11) - Laboratory Assistant,
Marks
Marks Percentage Year of Name of School / Board / College /
Exam Passed Stream Out
Obtained Of Marks Passing University
Of
HSSLC Or Equivalent (10+2) : SCIENCE 247 500 47 % 07/07/2023 Howajan HS School
Employment Exchange Registration
YES
No.
Employment Exchange Registration
1278r69/04/2022
No.
Date: 21/03/2025 14:02:14 Signature of Applicant

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