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Rajiv Gandhi University of Health Sciences, Karnataka


PGET 2011 Application Form

Ayurveda / Homoeopathy / Pharmacy / Nursing / Physiotherapy



* Subject :
* Name of the Applicant (as per sslc/10th marks card) :
* Mothers Name :
* Father's Name :
Spouse Name :
* Date of Birth : (dd/mm/yyyy)
*Gender :
*Place of Birth :
*Nationality :
*Qualifying Examination :
*College :
*University :
*Domicile of Karnataka? :
Professional Experience (in numbers) :
*Name of the Council :
*Registration No.:
Name of the state :
*Date of Completion CRI: (Format - dd/mm/yyyy)

* UG Marks Details
Phase/Year Maximum Marks Marks Obtained No. of Attempts
First Year
Second Year
Third Year
Fourth Year
Fifth Year
Total
(Total Attempts gets calculated)

* Do you claim reservation under PH Quota :
* Category:
Religion:
Caste:
Sub Caste:
* DD Amount:
* DD Number :
* DD Date : (Format - dd/mm/yyyy)
* Name of the Bank :
* Full Postal Address :
e-mail :
Phone :
Mobile :

INSERVICE    DETAILS

* Do You claim under Karnataka Government In-service Quota :
Department :
Present place of working :
Date of entry in to service : (dd/mm/yyyy)
Probationary Period declared :
Date of Declaration of Probationary Period :
(dd/mm/yyyy)
Deputed to PG Course :
Any enquiry is pending? :
Any departmental disciplinary action taken against the officer ? :
Whether under unauthorised absence? :