Public Health Department, Government of Maharashtra
ससरररननक आररगग वरभसग, महसरसषष शससन
Recruitment Process for Medical Officer Group-A Post for Advertisement No. :DPH/01/2024
जजहहरजत कमजमक : DPH/01/2024 सजठठ ववदककय अहधकजरठ गट-अ भरतठ पककयज
अरर क (Application No)
DPH/01/2024/13281
इइगजजत ननव (FullName in English) ANJALI SHANTARAM PATIL
मरनठठत ननव (FullName in Marathi) अइजलल शनइतनरनम पनटलल
जर ननव बदललल असलल तर इइगजजत
बदललल पपरन
र नव (If Name Changed,
Changed FullName in English)
वडडलनइचल/पनलकनइचल ननव SHANTARAM GOVINDA PATIL
(Father's/Guardian's FullName)
आईचल ननव (Mother's FullName) GAYABAI SHANTARAM PATIL
ललइग (Gender) ससज (Female)
वववनहहक सससतज (Marital Status) वववनहहत (Married)
MCSR (लहनन ककटकइबनचज घघषरन) ननयम, 2005 नकसनर तकमहल पनस आहनत कन? (Are हघय (Yes)
you Eligible according to MCSR (Declaration of Small Family) Rules,
2005 ?)
पवगर (Category) भटकयन जमनतज-क (NT-C / NT-2)
जनत (Caste) DHANGAR
पघटजनत (Sub-Caste)
तकमहनलन कघरतयन पवगनरतपन अजर भटकयन जमनतज-क (NT-C / NT-2)
करनयचन आहल ? (From which
Category you want to apply ?)
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ई-मलल आयडज (Email ID) [email protected]
मघबनईल क (Mobile No) 9172478060
जनमतनरलख (Date of Birth) 26-04-1997
आधनर क (Aadhaar No) 403152043719
पसवयवहनरनचन पतन (Correspondence AT-HOL, TAL-PACHORA,DIST-JALGAON, JALGAON,
MAHARASHTRA-424104
Address)
कनयमचन पतन (Permanent Address) AT-HOL, TAL-PACHORA,DIST-JALGAON, JALGAON,
MAHARASHTRA-424104
तकमचयनकडल महनरनषषनचल ववध अधधवनस पमनरपस आहल कन? (Whether You have valid हघय (Yes)
Domicile Certificate of Maharashtra?)
नसलयनस, अजरदनर शनसन पररपसक मकसज-१००७/प.क.-३६/कन.३६ हदननइक १0-०७-२००८ लनगप ननहल (Not
नकसनर महनरनषष-कननरटक सजमनवतर भनगनतजल मरनठठ भनवषक ८६५ गनवनइतजल रहहवनशज Applicable)
आहनत कन ? (If not, are the applicant a resident of Marathi speaking in
the Maharashtra-Karnataka border region 865 villages as per
Government Circular मकसज-१००७/प.क.-३६/कन.३६ dated 10-07-2008? ?)
जर अजरदनर ८६५ गनवनइतजल रहहवनशज असलल तर पररपसकनमधजल नमपद सपचजमधजल
सजलहन , तनलककन , गनव आणर गनवनचन अनककमनइक नमपद करन (If the applicant is a
resident of 865 villages, mention the district, taluk, village and village
serial number in the list mentioned in the circular)
रनषषलयतव (Nationality) भनरतजय (Indian)
MS-CIT ककइवन समतकलय पलशकर यशसवजररतयन पपरर कललल आहल कन? (Has Successfully ननहल (No)
Completed MS-CIT or Equivalent Training?)
मरनठठचल पकरलसल जनन आहल कन? (Whether Possesss Adequate Knowledge of हघय (Yes)
Marathi?)
अपपग आरकण (Differently Abled Reservation?)
a) अजरदनर अपइग आहल कन? (Whether applicant Differently Abled ?) ननहल (No)
b) हघय असलयनस, तकमचयनकडल SADAREM/ववदयककय मइडळनचल अपइगतव पमनरपस लनगप ननहल (Not
(ककमनन 40% व कमनल ५०%) आहल कन? (If Yes, Do you have Disability Applicable)
Certificate (Minimum 40% and Maximum 50%) of SADAREM/Medical
Board ?)
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c) हघय असलयनस, अपइगतवनचन पकनर? (If Yes, Type of Handicap?) लनगप ननहल (Not
Applicable)
तकमहनलन सपघररस कघरयनतपन अजर करनयचन आहल कन? (Whether you want to Apply from ननहल (No)
Sports Quota?)
अजरदनर अननस आहल कन? (Whether applicant have Orphan Status?) ननहल (No)
तकमहनलन महहलन कघरयनतपन अजर करनयचन आहल कन? (Whether you want to Apply from हघय (Yes)
Women Quota?)
अननवनयर रघटल हटइग इइटनरलशप पपरर करणयनचज तनरलख (31-01-2024 रघजज ककइवन तयनपपवर 27-12-2022
इइटनरलशप पपरर कररल आवशयक आहल ) (DD-MM-YYYY सवरप) (Date of Completion of
Compulsory Rotating Internship (Internship must be Completed on or before
31-01-2024) (DD-MM-YYYY Format))
NMC/MMC ननदणणचण तसररख (Date of MCIM/NCIM Registration)
ननदरज हदननइक (Registration Date) 17-01-2023
ननदरज कमनइक (Registration No) I-103724-A
ननदरज ववधतन तनरलख (Registration Validity date) 16-01-2028
कनलबनहय झनलयनस, नपतनजकररनचज तनरलख (If Expired, Date of Renewal)
तकमहल महनरनषष शनसन सलवलत कनयम आहनत कन? (Are you permanent in Maharashtra ननहल (No)
Government Service?)
महनरनषष शनसननचयन कघरतयन ववभनगनत? (In which Not Applicable
Department of Maharashtra Government?)
तकमहनलन कघरतयन पदनसनठठ अजर करनयचन आहल ? (For Which Post MEDICAL OFFICER - Group A for
you want to Apply?) BAMS Graduate
तकमहल भनरतजय/परदल शज पदवजधर आहनत कन? (Whether you are Indian / Foreign Indian
Graduate ?)
बजएएमएस गकर (BAMS Marks) Year Marks Out of Marks
1st Year 659 1000
2nd Year 664 1050
3rd Year 718 1150
4th Year 758 1110
All Year Total 2799 4310
All Year Percentage 64.94
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परदल शज पदवजधरनइसनठठ, NBE गकर (For Marks Out of Marks Percentage
Foreign Graduates, NBE Marks) 0 0 0.00
तकमचयनकडल पदवयकतर पदवज/डडपलघमन आहल कन, जर हघय तर हघय (Yes)
तपशजल दयन (Do you have any Post Graduate
Degree/Diploma, if yes give details)
हघय असलयनस, PG पदवज सतर (If Yes, PG Degree PG Degree Not Completed
Level)
Other
PG पदवज तपशजल (Details of PG Qualification)
सपलशलश लटल पदनवर ननवड न झनलयनस, तकमहनलन एमबजबजएस लनगप ननहल (Not Applicable)
पदनवर जनणयनस सवनरसय आहल कन? (If not selected on
Speciality Post, do you interested to go on MBBS
Post)
जर तकमचज सकरवनतजचयन फलरलत ननवड झनलल नसलल, तर तकमहनलन तकमचल ननव पनतकन यनदलत हघय (Yes)
ठल वणयनस सवनरसय आहल कन? (If you were not selected in the initial round, are
you interested in putting your name in the waiting list?)
तकमचयनवर कघरतनहल फफजदनरल गकनहन आहल ? (Any Criminal Offence against you ?) ननहल (No)
ततमहर ननरडलललर परसससप ग पसधसनगल (The posting preferences you have chosen)
Preference for MBBS/BAMS Posting :
Preference No Institute Post
1 Primary Health Center Kinhola MEDICAL OFFICER - Group A for
BAMS Graduate
2 Primary Health Center Undri MEDICAL OFFICER - Group A for
BAMS Graduate
3 Primary Health Center Janephal MEDICAL OFFICER - Group A for
BAMS Graduate
4 Primary Health Center Dhamangaon Badhe MEDICAL OFFICER - Group A for
BAMS Graduate
5 Primary Health Center Rohana MEDICAL OFFICER - Group A for
BAMS Graduate
6 Primary Health Center Atali MEDICAL OFFICER - Group A for
BAMS Graduate
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7 Primary Health Center Kalambeshwar MEDICAL OFFICER - Group A for
BAMS Graduate
8 Primary Health Center Kingaon Raja MEDICAL OFFICER - Group A for
BAMS Graduate
9 Primary Health Center Hirdav MEDICAL OFFICER - Group A for
BAMS Graduate
10 Primary Health Center De. Sakarsha MEDICAL OFFICER - Group A for
BAMS Graduate
11 Primary Health Center Takarkhed MEDICAL OFFICER - Group A for
BAMS Graduate
12 Primary Health Center Wankhed MEDICAL OFFICER - Group A for
BAMS Graduate
13 Primary Health Center Wadner Bholji MEDICAL OFFICER - Group A for
BAMS Graduate
14 Primary Health Center Raigaon MEDICAL OFFICER - Group A for
BAMS Graduate
15 Primary Health Center Jamod MEDICAL OFFICER - Group A for
BAMS Graduate
16 Primary Health Center, Ray Pimpalgoan MEDICAL OFFICER - Group A for
BAMS Graduate
17 Primary Health Center, Nalni B. MEDICAL OFFICER - Group A for
BAMS Graduate
18 Primary Health Center, Khasgoan MEDICAL OFFICER - Group A for
BAMS Graduate
19 Primary Health Center,Warud B. MEDICAL OFFICER - Group A for
BAMS Graduate
20 Primary Health Center, Pirpimpalgoan MEDICAL OFFICER - Group A for
BAMS Graduate
21 Primary Health Center,Talani MEDICAL OFFICER - Group A for
BAMS Graduate
22 Primary Health Center, Varkhedi MEDICAL OFFICER - Group A for
BAMS Graduate
23 Primary Health Center, Shendurni jamner MEDICAL OFFICER - Group A for
BAMS Graduate
24 Primary Health Center, Paldhi MEDICAL OFFICER - Group A for
BAMS Graduate
25 Primary Health Center, Nagardevala MEDICAL OFFICER - Group A for
BAMS Graduate
26 Primary Health Center, Kajgaon MEDICAL OFFICER - Group A for
BAMS Graduate
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27 Primary Health Center, Anturli MEDICAL OFFICER - Group A for
BAMS Graduate
District Prefrences for MBBS/BAMS :
Preference No District
1 Buldhana
2 Jalna
3 Jalgaon
4 Chatrapati Sambhaji Nagar
5 Akola
शशकणणक/तसपततक/वगसरससनगक अभगससकम मसहहतण तपशणल (Details of Educational/Technical/Professional
Course Information) :
पररकस उतणणर रषर एककण गतण सककलरसरर गलड
पररकस सतर (Examination
(Examination) (Passing रमळसलल (Percentage) (असलगसस)
Level)
Year) (Total (Grade [If
Marks Any])
Obtained)
वरशलष वरषग एककण गतण गलड अथरस शलणण नमकद
बरडर/गतननररसरसर
(असलगसस) (Total Out आहल कस?
(Board/University)
(Specialisation [if Of Marks) (mention Grade or
Category instead
Any])
of Marks)
10th SECONDARY 2013 452 90.40
SCHOOL
CERTIFICATE
EXAMINATION
MAHARASHTRA STATE 500 N
BOARD OF SECONDARY
AND HIGHER
SECONDARY
EDUCATION,PUNE
12th HIGHER 2015 507 78.00
SECONDARY
CERTIFICATE
EXAMINATION
MAHARASHTRA STATE 650 N
BOARD OF SECONDARY
AND HIGHER
SECONDARY EDUCATION
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Graduate Degree BAMS EXAMINATION 2021 2799 64.94
MAHARASHTRA 4310 N
UNIVERSITY OF HEALTH
SCIENCES
अनतभरसचस तपशणल (Details of Experience Information) :
सपसथलचस पकसर (Type of सपसथलचल नसर आणण पतस तसरखलपससकन एककण अनतभर(Total ननगतकतणचल सररप
Organisation) (Organisation Name (From Date) Experience) (Nature of the
and Address) Appointment)
पद (Post Held) तसरखलपगरत (To रलतन तपशणल
Date) (Salary Detail)
आपण अरर कललललर पदल (The Posts you have applied for) :
अरर कललललर पदल (Post Applied)
MEDICAL OFFICER - Group A for BAMS Graduate
अरर फफ महणकन ततमचगसकडकन ऑनलसइन रककम पसपत झसलर (Online Amount Received from you as
Application Fees) :
वगरहसरसचण तसररख वगरहसर आगडण (Transaction ID) रककम (Amount)
(Transaction Date)
17-02-2024 17Feb20241142499199KVQHA 700.00
16-02-2024 16Feb20241138149101B8NMV 700.00
एककण रककम (Total Amount) 1400.00
आपण आपलरड कललललगस कसगदपतसपचण गसदर (List of documents you have uploaded) :
अनत. क (Sr. No) अपलरड कललललगस कसगदपतसपचस तपशणल (Details of documents uploaded)
1 रइ दल 100 वपकसलल आणर उइ चज 140 वपकसलल असलललन अजरदनरनचन फघटघ (Applicant Photo having
Width 100 Pixel and Height 140 Pixel)
2 रइ दल 100 वपकसलल आणर उइ चज 50 वपकसलल असलललल अजरदनरनचज सवनकरल (Applicant Signature
having Width 100 Pixel and Height 50 Pixel)
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3 आधनर कनडर / डनयसवहइ ग लनयसनस / पशन कनडर / पनसपघटर सनरखन फघटघ आयडज (Photo ID Like
Aadhar Card / Driving License / PAN Card / Passport)
4 वयनचन पकरनवन - शनळन सघडलयनचन दनखलन (Proof of Age - School Leaving Certificate)
5 जनतजचन दनखलन (Caste Certificate)
6 जनत ववधतन पमनरपस (Caste Validity Certificate)
7 अदयनवत ननन ककमज ललयर पमनरपस (Updated Non Cremy Layer Certificate)
8 अधधवनस पमनरपस (Domicile Certificate)
9 लहनन ककटकइब घघषरनपस (Small Family Declaration)
10 अजनरतजल ननवनचन पकरनवन एस. एस. सज. असवन ततसम शवकणरक अहतनर (Proof of name in
application form (S.S.C. or equivalent Educational Qualification)
11 यन वयनतररकत पनसतलशज इतर कघरतलहल सइबइधधत दसतऐवज (Apart from this any other
Documents related to Eligibility)
12 इइटनरलशप पपरर कललयनचल पमनरपस (Internship Completion Certificate)
13 NMC/MMC ननदरज पमनरपस (NMC/MMC Registration Certificate)
14 सवतनचल घघषरनपस (Self Declaration)
15 शवकणरक पनसतन टश बमधयल नमपद कललललल सवर बघडर/पदवज पमनरपसल एकनच पजडजएफ फनइलमधयल अपलघड
करन (Upload All Board/Degree Certificates which are mentioned in Educational
Qualification Tab in Single PDF File)
DECLARATION
मज, यनदवनरल , गइभज
भरलललल सइपपरर मनहहतज मनझयन मनहहतजपमनरल सतय आणर बरघबर आहल . मज कघरतजहल भफनतक मनहहतज लपवलललल ननहल, तसन
यलसल सनदर कललललल कघरतजहल मनहहतज फसवज, चकककचज ककइवन असतय आढळलयनस, मज
हघणयनस जबनबदनर असपन पदनवरलल ननवड दल खजल रदद हघणयनस जबनबदनर आहल . मज
आणर मज तयनइचल पनलन करणयनस सहमत आहल . मज यनदवनरल यन ननयमनइचज सइपपरर कनयदल शजरतन, ववधतन आणर शकदधतन सवजकनरतघ.
मलन समजतल कक हन अजर सबलमट करन मज यन सवनरचज शकदधतन, ववधतन आणर/ककइवन नयनययतन सवजकनरलल आहल . मज
आवशयक कनगदपसल अपलघड करणयनचल वचन घलतघ, तयनत अयशसवज झनलयनस मनझन ननवडजचन दनवन मइजपर कललन जनरनर ननहल.
मज दसतऐवज पडतनळरजचयन वलळज तसलच ननवड पककयलचयन वलळज ननयमनइनकसनर सवर आवशयक मपळ पमनरपसल सनदर करणयनचल
वचन घलतघ, असल न झनलयनस मनझन ननवडजचन दनवन मइजपर कललन जनरनर ननहल असल मलन समजतल.
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I,hereby,solemnly and sincerely affirm that each and every statement made and the entire information
filled in the above online application form is true and correct to the best of my knowledge. I have not
concealed any material information, however if any information submitted herein is found fraudulent,
incorrect or untrue, I understand that I am liable to criminal prosecution and my selection to the Post
is also liable to be cancelled. I have carefully read the rules & regulations of Recruitment and I agree
to abide by them. I hereby accept in entirely the legality, validity and correctness of these rules. I
understand by submitting this application I have accepted the correctness, validity and/or justifiability of
all these and that. I undertake to upload all the required Documents, failing which I understand that
my claim for selection shall not be granted. I undertake to submit all the required original certificates
at the time of Document Verification as well as at the time of selection process as per the rules,
failing which I understand that my claim for selection shall not be granted.
Online Application Submit Date : 17-02-2024
Signature of Applicant
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