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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—1234567

3.

Have you done Senior Residency earlier, if yes, Then Details there of

1.

Name

2.

Father's Name / Husband's Name

3.

Date of Birth

4.

Age in years

5.

Mobile No

6.

Permanent Address

7.

Correspondence Address

8.

E-mail Address

9.

Aadhar No

10.

Whether you belongs to SC, BC or Differently abled ( if yes only then attach proof thereof )

—Please choose an option—yesno

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)

14.

Total Rural Service (Category 1 to 5)

15.

Punjab Medical Council Registration Number

16.

Do you have serve Bond with Govt. of Punjab Yes/No

—Please choose an option—YesNo

17.

Whether probation has been cleared Yes/No

—Please choose an option—YesNo

18.

NOC from Competent authority (compulsory for category 1 to 5) (attach Proof)

—Please choose an option—YesNo