Malabar Cancer Centre Thalassery

APPLICATION FORM FOR THE POST OF TECHNICIAN NUCLEAR MEDICINE

Application No:

01. Name of the Candidate as in records
(in Capital letter)
02. Sex

03. Date of Birth (Best viewed with Mozilla Firefox 3.5 or above/GoogleChrome)
04. Address for communication

District: State: PIN:

05. Religion
06. Caste
07. Category
08. Nationality
09. Mobile No
10. Phone No
11. E-mail
12. Educational Qualification
Examination passed Discipline/ Specialization College/ Institute Board/ University Year of Passing Marks in % Class/ Grade
13. Experience (Date should be in DD-MM-YYY format)
Organization Designation From Date
(dd-mm-YYYY)
To Date
(dd-mm-YYYY)
Months Job Profile Salary
Any Specialized Training Obtained
Other details if any
Declaration: I hereby declare that I have carefully read and fully understood all the instructions and details pertaining to the post being applied by me and all statements made and information furnished in this application are true and complete to the best of my knowledge and belief. I also declare that I have not concealed any material information which may debar my candidature for the post applied for. In the event of suppression or distortion of any fact including category or educational qualification, etc. made in my application form, I understand that I will be denied any employment in the Institute and if already employed on any of the posts in the Institute, my services will be terminated forthwith. I have also read and understood about the selection procedures and the interview guidelines and will abide by the rules of the centre.
 

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Web: www.mcc.kerala.gov.in