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Application For Admission To Post Basic B.Sc Nursing Course

*
Expansion of Initial(s)
Age and Date of Birth *
Sex* Male Female
Marital Status (Whether Married/
Unmarried/ Divorced/ Widow) *

Caste and Religion
Name of the Parent/Guardian/Spouse
Occupation of the Parent/Guardian/Spouse
Annual Income
Nationality
E-mail *
Mobile/Telephone *
Address for Communication *
Permanent Address*
Address of the Parent/Guardian/Spouse
Whether in service or not* Yes No
Name & Address of employer
Whether deputation or study leave or extraordinary
leave or private candidate*

Academic Qualification : Details of Matriculation and above examination only be given
Exam Passed University/Board Subject taken Year of
passing
Roll No Maximum Marks Marks Obtained Division/Class % of Marks
Registration Details
State of Registration Year of Registration Register No. of Nurse Register No. of Midwife
Professional Qualification
Exam Passed Institution University/Counsil Year & month when passed % of Marks Duration of course
Details of Experience in Nursing
Post held Institute / Hospital From To Total Experience
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