Application For Employment(up-nhm)

Personal Details

Post Applied for* Upload Photo:

Image size should be less than 400kb.

Complete Name as per records*
Name of Father/Husband & Relationship *
Nursing Council Registration No.

Only for nurse cadre positions

I. Present Address*
Mobile Number *
Telephone Number
Alternative Mobile Number
II.Permanent Address (if different)
Mobile Number
Telephone Number
Date of Birth*
Are you Domicile of Uttar Pradesh
Marital Status

Educational Details

(Start with 10th till higher education in chronological order)

Name of Exam* Board / University* Year of passing* Subject Div/ Grade

Current Employment Detail

(In case currently unemployed, please mention the previous employment details)

Employment Status
Name of organization, address & Telephone number*
Position held/ Designation*
Duration (in date format)*
Nature of duties & responsibilities*
Major Achievement
Major areas of interest
Type of employment (Regular/ contract/ Ad-hoc Assignment)
Gross Emolument per month*

Previous Experience

(In case you don’t have previous experience, please mention current employment details)

Name of organization* Duration (in date format)* Position held* Nature of duties and responsibilities (in brief) Gross emolument per annum in INR*

Please highlight relevant experience possessed by you as required in the position-JD: And also highlight your job achievements if any.*

Other Details

Have you ever been interviewed by NHM UP(if yes, when and for what position)*
Are you willing to be posted anywhere in UP?
Joining time required if selected:
Do you have any relatives working in NHM UP? If so, specify the details (name, designation, location)

Knowledge of Languages

Language* Level*
Name & Address of two references (Not relatives) with telephone/fax/ e-mail id*


Signature of Candidate* Signature should be less than 50kb.


I hereby declare that above information furnished by me is true to the best of my knowledge and belief. Information submitted by me is subject to verification at any point during my association with UP NHM