APPLICATION FOR SELECTION FOR TRAINING PROGRAMME FOR EMPLOYBILITY AND SKILL ENHANCEMENT
(ADVT. NO.: HR-T&M/1090, DATE: 09-09-2025)
NAME OF THE TRAINING PROGRAMME:
Medical Attendant Training
Hospital Administration Training
Anesthesia/OT Assistant Training
Select a Training Programme
*Required Field
(1) Name in Full:
*Required Field
*Maximum 50 characters allowed.
(2) Father's Name:
*Required Field
*Maximum 50 characters allowed.
(3) Date Of Birth:
*Required Field
(4) Sex:
Male
Female
(5) Age as on:
(6) Nationality:
*Required Field
*Maximum 20 characters allowed.
(7) Religion:
Select a Religion
HINDUISM
ISLAM
CHRISTIANITY
SIKHISM
JAINISM
BUDDHISM
OTHERS
*Required Field
(8) Marital Status:
Single
Married
(9) Caste/Category
SC
ST
OBC
EWS
GEN
(10) Identity Proof(Aadhar No.)
*Required Field
*Enter 12 Digit No. only
(11) CORRESPONDENCE ADDRESS
House No.
Village/Town
*Required Field
Block/Area
*Required Field
Post Office
*Required Field
District
Select a District
Angul
Boudh
Balangir
Bargarh
Balasore
Bhadrak
Cuttack
Deogarh
Dhenkanal
Ganjam
Gajapati
Jharsuguda
Jajpur
Jagatsinghapur
Khordha
Keonjhar
Kalahandi
Kandhamal
Koraput
Kendrapara
Malkangiri
Mayurbhanj
Nabarangpur
Nuapada
Nayagarh
Puri
Rayagada
Sambalpur
Subarnapur
Sundargarh
*Required Field
State
ODISHA
Pin
*Required Field
*Pincode should be numeric and 6 digit no. only
Is your Permanent Address same as your Correspondence Address?
Yes
No
(12)PERMANENT ADDRESS
House No.
Village/Town
*Required Field
Block/Area
*Required Field
Post Office
*Required Field
District
*Required Field
State
Pin
*Required Field
*Pincode should be 6 digit no. only
(13) Contact Mobile No.:
*Required Field
*Enter 10 digit no. only
(14) Email ID:
*Invalid Email Address
(15) Educational Qualifications (from Matriculation onwards):
Examination Passed
Subjects
Name of the Board/University
Year of Passing(YYYY)
*Required Field
*Required Field
*Required Field
*Enter 4 digit no. only
*Enter 4 digit no. only
(16) Experience, if any :-
Name of the Hospital & Address
From(DD/MM/YYYY)
To(DD/MM/YYYY)
Total Period(in days)
*Date was in incorrect format
*Date was in incorrect format
*Date was in incorrect format
*Date was in incorrect format
(17) Whether presently employed with any Public Sector Undertaking/Autonomous Body/Govt. Deptt. ?
Yes
No
A set of Self Attested photocopies of the documents in support of the above declaration shall be produced at the time of Interview