APPLICATION FORM

(Please fill in block letters)

2005-12

Attested
Post Applied for
Photograph

1. First Name: Last Name:

2. Date of Birth: Age as on 01.08.2010 3. District of Domicile:

4. Sex:

5. Please mention if SC/ ST/ OBC: General

6. Present Contact Address: 7. Permanent Telephone No:

(STD Code) Number

8. Present Telephone No:

Permanent Contact Address: (std code)
Office number

9. Email Address: 10.Mobile No.:

11. Languages spoken/written:

12. Computer Literacy:

13. Education: High school onwards, please list all your qualifications
Marks Full/Part Time/
Degree Institute/Board & Location Year Full Marks % Distance
Mark Secured Learning
Matriculation
+2
+3
P.G
Computer
qualification
Additional
Qualification if any.
 1 4. Employment Record:
Total years of post qualification experience :
Years of experience in the Development Sector / NGO :
Years of experience in Government :
15. Details of Employment: (Use separate sheets if required).
Starting with your present employment, list in reverse order all the employments you have had.
16 A. Current Employment:
From To Designation
Month / Year Month / Year
Till date
Location of Employment:

Description of your duties:

16B. Previous Employment:

From To Designation
Month / Year Month / Year

Location of Employment:
Description of your duties:

16C. Previous Employment:

From To Designation
Month / Year Month / Year

Location of Employment:

Description of your duties:

Signature of the Applicant

Note:
1. Two copies of passport size colour attested photograph to be submitted alongwith the application.
2. The following documents are to be enclosed alongwith the application:
a) Residential certificate issued by the Tehsildar/Sub-Collector etc.(duly attested not less than six months)
b) Attested photo copies of all mark sheets & certificates in proof of the claim made by the candidate
relating to his educational qualification.
c) Experience certificate if any.

MODALITIES FOR APPOINTMENT OF BLOCK PROGRAMME ORGANIZER

REQUIRED QUALIFICATION

• The candidate should be a graduate in Commerce/Science/Arts with Post Graduate Diploma in

Computer Applications from a recognized Government Institution.
• S/he must have completed graduation with a minimum of 55% marks and should be below 35
years of age as on 01.08.2010.
• Preference will be given to candidates possessing Post Graduate Qualification in
Management/Statistics/Health Education and those having experience in this field.
• The candidate must be permanent resident of the district s/he is applying for.
• Residential Certificate is to be produced while applying for the post.

JOB RESPONSIBILITIES
• Work in close consultation with Medical Officer in charge of the block to ensure smooth and
effective planning and implementation of NRHM and other health programmes.
• Accounting and financial management including programme implementation at the block,
sector, sub-centre, village level and to assist PRIs & ANMs in proper maintenance of
accounts /cash books and submission of SoEs /UCs.
• Create and maintain Block resource database for the health sector and assist in optimal use of
resources.
• To maintain receipt and expenditure of the Committees.
• Will be responsible for disseminating of information at the grassroots.
• To co-ordinate with NGOs and other departments for inter-sectoral convergence.
• Any other job as assigned by the Block Medical Officer, DPMU and CDMO from time to
time
.
TERMS AND CONDITIONS:

• The engagement is purely contractual in nature and can be terminated at any point without
citing any reasons thereof.
• Candidates once engaged cannot claim for re-engagement under any conditions as a matter of
right.
• The contract is initially for a period of eleven months and further extension will be provided
on assessment of the performance of the period in service.

Note:
1. Two copies of passport size, coloured, attested photograph to be submitted alongwith the
application.
2. The following documents are to be enclosed alongwith the application:
a) Residential certificate issued by the Tehsildar/Sub-Collector etc.(not less than 6 months)
b) Attested photo copies of all mark sheets/certificates in proof of the claim made by the
candidate relating to his educational qualification.
c) Experience certificate if any.
d) Work certificate, date of joining & date of retrenchment from the Project (in case of
candidates who are availing benefits of previous projects etc.)

REMUNERATION
Monthly remuneration shall be Rs 10,000/-(consolidated)