APPLICATION FORM FOR HOUSE JOB (FOUNDATION YEAR)

MAYO HOSPITAL LAHORE

Form Number Merit Number

(Office use only) (Office Use Only)
Applicant Name Paste

S/o, D/o, W/o Passport Sized

Date of Birth Photograph

(DD-MM-YY)
Do not staple
NIC Number

Date of Graduation Nationality

(MBBS) Month/Year
Institute from where Religion
graduated
District of Domicile

PMDC Provisional Blood

Registration Number Group
Email Address

Telephone (R) (M)

Passport Number (foreigners)

Mailing
Address

Permanent
Address
(if different from
above)

Bank Account Bank/

Number Branch
Matric/Equivalent Medals/
Percentage Honors
FSc/Equivalent Medals/
Percentage Honors
Medical Graduation MBBS / Equivalent:_______

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 APPLICATION FORM FOR HOUSE JOB (FOUNDATION YEAR)
MAYO HOSPITAL LAHORE

Professional Marks Division Distinctions University/College Medal(s) Attempt(s)

Position
First - I

First - II

Second

Third

Final

Rotation Preference (Please mention your preferred rotations in order of priority) Row 5 and 6 are for
additional rotations beyond the foundation year.
Rank Preferred Rotation

Declaration
I do hereby solemnly declare that the information given by me in this application form is true and
correct to the best of my knowledge and belief. I fully understand that the facts given above will serve
as the basis for determination of my eligibility by the concerned authorities. My candidature so
determined by the board/authorities will stand provisional until it is verified with the original certificates
at the time of interview. I will not claim benefit of any information which is not mentioned in the
application form and is produced later on.
I declare that I have not been already employed anywhere for housejob and I am submitting my
application through proper channel and I will ensure that I shall resign from my existing post (if any)
when selected.
I undertake to serve for the term of one year in case of selection as an internee house
surgeon/physician.
I solemnly declare that I shall be legally bound to surrender my security of Rs. 1000/- in case I leave my
internship before due date.
I undertake to produce the registration of PMDC.
I have also read the rules and regulations and I am submitting the affidavit on judicial paper worth Rs.
50/- duly signed and attested by the oath commissioner.

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 APPLICATION FORM FOR HOUSE JOB (FOUNDATION YEAR)
MAYO HOSPITAL LAHORE

I also understand that after the submission of application, if my application stands incomplete, wrongly
filled, unsigned or misstated in the above replies, disciplinary action shall be taken against me under the
rules.

Signature of the Applicant

Official Use Only

Comments/Status

 The form is to be submitted to the office of the Medical Superintendent, Mayo Hospital according to the
notified schedule.
 Lists of selected HOs based on merit shall be displayed on the University Notice Boards as well as at the
websites www.kemu.edu.pk and www.mayohospital.gop.pk
 Applicants are required to submit the online
 Documents to attach (Attested Photostat copies)
a. Matric Certificate
b. FSc Certificate
c. MBBS Degree
d. Result cards of all professional exams
e. Attempts certificate
f. Medals, positions and distinctions certificates (if applicable)
g. NIC/Passport
h. Domicile
i. PMDC registration
j. Three passport size photographs (one to be pasted on the front page and two to be
stapled)
 Please provide no dues certificate from warden boys/girls hostel, KEMU Lahore
 Please note: No application shall be entertained without the above documents
 Compulsory Rotations:
a. Medicine
b. Surgery
 Every applicant must opt for the two compulsory rotations of three months each. The third and
fourth rotation will be optional in allied specialties of medicine and surgery.
 Details and breakup of allied specialties is available at www.kemu.edu.pk and
www.mayohospital.gop.pk

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 APPLICATION FORM FOR HOUSE JOB (FOUNDATION YEAR)
MAYO HOSPITAL LAHORE

 5th and 6th rotations are extended rotations, of six months each. These will be offered after
completion of foundation year. These are not mandatory.
 Applicants will be divided into 4 batches based on preferences and rank ordering in accordance
with their merits. Each batch will then be rotated according to their preferences.
 The same form can be accessed and submitted online at www.kemu.edu.pk and
www.mayohospital.gop.pk.

Sample Affidavit to be submitted on judicial paper of Rs. 50/- attested by oath commissioner.

I Dr. ____________________ s/o, d/o _______________, house officer, Mayo Hospital, Lahore do
hereby solemnly declare and affirm as under:
1. I will not take part in any association/union
2. I will not take part in any subversive activities i.e. strikes, demonstrations, slogans, etc
3. I will be bound to abide by the rules, regulation and orders issued by the hospital authorities. I
have read the rules and regulations carefully
4. That if, I am found indulged in any such activities and violations of rules and regulation, my
house job will be liable to be terminated
5. Being Kemcolian, once I utilize my merit for honorary job, I will not claim a paid house job
6. Being non kemcilian, I will not claim any paid job
Signature ______________
Name: Dr. _____________
Phone No. (res) _________
Mobile: _______________
Address:_______________

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