Date of interview – **th July **** at **** hrs

CAPITAL DEVELOPMENT AUTHORITY

CAPITAL HOSPITAL ISLAMABAD

Photograph

APPLICATION FORM HOUSE JOB TRAINING

PMDC Registration No (Valid from to )

PARTICULARS OF CANDIDATE

Name of the candidate

Father’s / Husband name

Name of College

Date of birth Domicile Nationality

CNIC No. Mobile No.

Date of passing MBBS Session From To

Note: Candidate who has passed final examination during last 12 months upto closing date of submission of application will be considered as Fresh Candidate.

DETAILS OF PROFESSIONAL EXAMINATIONS OF MBBS

Professional Examination

Date of Passing

Marks

Attempts Availed

Marks Obtained

Max. Marks

1st Professional

(Part-I)

1st Professional

(Part-II)

2nd Professional

3rd Professional

4th Professional / Final year

Either CDA Employees’ son or daughter (Yes) (No)

If yes then please provide documentary evidence

Page – 1 / 2

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GENERAL

a. Have you ever been removed or expelled from any Institution? Yes / No

(if yes)

i.Name of the Institution

ii.Year Period of removal/expulsion

iii.Reason for punishment

b.Any disciplinary action other than removal / expulsion taken against you like fines,

compulsory migration etc. Yes / No

c.Have you ever been convicted? Yes / No

d.Are you suffering from any illness or disability? Yes / No

e.Have you received any house job training? Yes / No

(if yes) Name of Hospital Specialty from to

I hereby solemnly declare that:

i.I have not completed one year House Job in any other institution/hospital.

ii.Will abide by the statues, Regulations and Rules etc framed by the Capital Hospital, Islamabad from time to time.

iii. Will maintain good behavior and pay all dues regularly.

iv. Will work diligently and maintain the dignity and prestige of the Capital Hospital, Islamabad both in and outside the Hospital.

v.Will be a full time and regular trainee of the Capital Hospital and shall not accept any employment during the training period.

vi.That I will join the house job training for 06 months. If I want to quit the training in between then I shall submit my resignation one month before of its commencement otherwise I will pay one month’s stipend in lieu of notice period.

vii.The information given in the Application Form is correct to the best of my knowledge and belief. And if anything is found incorrect, Capital Hospital Islamabad will have the right to terminate my House Job.

Dated

Signature

Full Name

Present Address

Permanent Address

Following Documents are enclosed herewith: -

a.MBBS (all professionals)

b.Attempts / Academic certificate from the Principal

c.Provisional Registration from PMDC

d.National Identity card

e.Two recent photographs

Contact this candidate