SR Application
Dr. B.R. Ambedkar State Institute of Medical Sciences, Sahibzada Ajit Singh Nagar (Mohali), Punjab
Email address *
Name of Applicant Doctor *
Fathers Name *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Mobile Number *
Posting of applicant (not applicable for fresh candidates)
Probation Period is cleared ?
Address *
Category *
Total Rural Service (in months) as on last date of application
Attach detail of rural service with hard copy of application
Percentage of Marks in MBBS (all Profs) *
Attach summary of marks obtained and total marks of each year with hard copy of this application
Percentage of Marks in MD/MS *
Attach summary of marks obtained and total marks of each year with hard copy of this application
Number of Attempts in MD *
Specialty of MD/MS *
DM/Mch. *
Category as defined in SR Notification dated 10.04.2018 *
1st Choice of Specialty for SR *
2nd Choice of Specialty for SR
3rd Choice of Specialty for SR
Residency already done *
Have you filled PG Bond from during PG *
Signature on print out (After Submission)
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A copy of your responses will be emailed to the address you provided.
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