1/17/2019 ESIC Paramedics Form 2018

Applicant Details

Personal Details

Application Sequence No

ESICP301034

Candidate's Name
BANDARU ANASUYA

Father's Name Mother's Name

BANDARU NARAYANA BANDARU LAKSHMI DEVI
Marital Status

Married

Nationality
a citizen of India

Post Applied

Post Applied Post Code

Staff Nurse 17

Preferred State/City of Posting

Telangana

Center Choice 1 Center Choice 2

Kurnool Vijayawada

Center Choice 3 Category

Hyderabad UR
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Gender Date of Birth (DD-MM-YYYY) same as Matriculation/

Secondary Certificate
Female
10/May/1989

Age as on 21.01.2019 Are you Physically Handicapped (PH) (degree of disability

40% or above)?
29 Years 8 Months 11 Days
No

Are you an Ex-Service man? Were you originally domiciled in the state of Jammu and
Kashmir between 01.01.1980 and 31.12.1989 ?
No
No

Are you a Government servant? Are you an employee of ESIC?

No No

Any other category for relaxation in age

No

Contact Details

Mobile Number
8985340956 Email ID
boornenisuresh6@gmail.com

Present Address

Address Line 1
H.NO 1-46,GONAVARAM VILLAGE

Address Line 2
PANYAM MANDAL, KURNOOL DISTRICT

Country
India

State City

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Andhra Pradesh Kurnool

Pin Code
518176

Permanent Address

Address Line 1
H.NO 1-46,GONAVARAM VILLAGE

Address Line 2

PANYAM MANDAL, KURNOOL DISTRICT

Country
India

State City
Andhra Pradesh Kurnool

Pin Code
518176

Matriculation (10th)/Equivalent Details

Name of the Board/Council

ssc

Year Of Passing

2004 Subject Combination

telugu

% of Marks
75.33

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Intermediate (12th)/Equivalent Details

Name of the Board/Council

board of intermediate education

Year Of Passing

2006 Subject Combination

BIPC

% of Marks
73.2

Diploma/UG Degree Details

Diploma/UG Course Name

Diploma Degree

Specialization Year Of Passing

General Nursing and Midwifery or equivalent 2010

Percentage of Marks

74.5

Post Graduate Degree Details

PG Degree Name
MSC NURSING

Specialization Year Of Passing

COMMUNITY HEALTH NURSING 2015

Percentage of Marks

70.4

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Previous Work Experience Details

Are you registered & qualified as pharmacist under Pharmacy Act, 1948 ?

Yes

Registration Number
RN106239,RM105804

Previous Work Experience Details (latest to earliest)

Sr. Designation/Post Organization/ Employer From Date To Date No. of

No. years of
Service

1 LECTURER SANTHIRAM NURSING 01/03/2016 17/01/2019 2 Year(s)

COLLEGENANDYAL 10
Month(s)

2 STAFF NURSE SANTHIRAM GENERAL 02/03/2011 02/09/2013 2 Year(s) 6

HOSPITALNANDYAL Month(s)

Total Work Experience

5 Year(s), 4 Month(s)

Payment Details

Amount to be Paid

250

Beneficiary Name Banke Name

B SURESH SBI

Account Number IFSC Code

32605118556 SBIN0010577

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Candidate Documents/Images Upload Details

Photo

Signature

Declaration

I hereby, solemnly declare that information provided by me in the form is true to the best of my
knowledge and belief. I understand that my candidature is subject to the conditions laid down in the
adverisement brochure. I further declare that I am not involved in any criminal case and/or no such
case is pending against me in any court of law.

Version 13.05.01

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