Home Test Application Proforma For the post of Senior Resident Advt. No. DPR/Pb/2329/12/2025/1391 and DPR/2329/12/2025/1391 ( The Last date of Application is 10-08-2025 upto 5:00 PM ) (*File should be 50 to 100kb in jpg/PDF format) To Director Principal Govt. Medical College, Patiala. Subject: Application for the Post of Senior Resident at Govt. Medical College, Patiala. Recent Photo Part-A 1. Choice of speciality (maximum 3) 2. Category (1-7)under which you are applying (For details of each category see Punjab Govt. Notification No. 1/70/2022-2HB3/2268 dated 23.08.2022 ) —Please choose an option—123457 Part-B 1. Name 3. Date of Birth 4. Age in years 5. Mobile No 6. Permanent Address 8. E-mail Address 9. Aadhar No 11. Present designation and posting(In case of Category 1 to 5) 12. Date of Joining in service 13. Attach Details of Service (Service Certificate from the Controlling Authority) (compulsory for Category 1 to 5) —Please choose an option—1 to 56, 7 14. Total Rural Service (Category 1 to 5) 16. Have you filled PG Bond with Govt of Punjab ( Cat 6-7 ) —Please choose an option—Yes (All India Quota)Yes (State Quota)No Part C-Details of Qualification Details of MBBS Details of M.D. / M.S. 2 Specialty in which MD/MS College University Date of Degree Total Marks Marks Obtained %age File Upload M.D./M.S. No. of Attempt in M.D. / M.S. (please attach attempt certificate) M.D. / M.S. Degree Details of D.M. / Mch 3 Subject in which DM/Mch passed Total Marks Marks Obtained %age DM/M.Ch 4 have you been Convicted by any court in India / Abroad Whether any vigilance / Departmental enquiry is pending (If yes details there of ) Certified that particular given above are true and correct to the best of my knowledge and nothing has been concealed therein Place: Date: Name: Signature: Note: The Copy of the online submissions will be automatically emailed to your above mentioned email account.