Registration Form for the Post of CHO



Post Applied For* :
Please Select the Post
 District Applied For*:
Please Select District Applied for

Name of Applicant*:
Please Enter the Fisrt Name Of Applicant



Father's Name*:
Please Enter the Father's Name Of Applicant
 Mother's Name*:
Please Enter the Mother's Name Of Applicant
Whether Applicant is Currently working in NHM, Haryana ?
Whether Applicant is Parmanent resident of Haryana State and having Haryana Domicile Certificate ?
Please Select have Haryana Domicile or not


Whether applicant belongs to Ex-Serviceman Category?
Please Select Ex-Serviceman or not
Whether applicant herself / himself is Ex-Serviceman Category Fill 'H' ?
(In case of Ex Serviceman Dependent, then applicant needs to fill "D")
Please Select Ex-Serviceman or not
 Year of Service
(i.e. Complete Year)

Category
Please Select Category
 Date of Birth (DD/MM/YYYY)*:
*Please Select DOB from Calender only
Please Enter Date Of Birth
Mobile No*.
(for Future Contact)
Please Enter Mobile No
 Email Id*:
(for Future Contact)
Please Enter Email Id

Year of Passing Matric
Enter Year of Passing
 Roll No of Matric
Enter Matric Roll No.

Whether Hindi/Sanskrit subject upto Matriculation level ?

Whether applicant is BAMS or B.Sc. / Post Basic B.Sc. Nursing Degree Holders, and completed her/his six month Mid-Level Health Provider's Bridge Course Programme on Certificate in Community Health for Nurses (BPCCHN) from IGNOU or any State University/ Institution ?
OR
Whether applicant is B.Sc. / Post Basic B.Sc. Nursing Graduates, and completed her/his Degree with Mid-Level Health Provider's Certificate Course (BPCCHN) integrated in the curriculum of B.Sc. / Post Basic B.Sc. Nursing ?
OR
Whether applicant is persuing B.Sc. / Post Basic B.Sc. Nursing Degree, and appeared in her/his Final Year Exam with integrated Mid-Level Health Provider's BPCCHN Course in their Curriculum; Subject to the condition that she/he has to submit the final year Detailed Marks Certificate (DMC) alongwith copies of all Previous year DMCs at the time of document verification. The Candidate, who will not be able to produce her/his final year DMC at the time of Document Verification shall not claim for the final Selection ?
OR
Whether applicant is BHMS ?

Note: Applicant should ensure that all above information filled for Registration is correct as per your credentials. Once it is submitted for Registration, you will not be able to change any information and you will not be able to re-register yourself. Further, you will be allowed for filling up application form in case you are eligible as per above information.

Declaration: I do hereby declare that the information furnished above is true, complete and correct to the best of my knowledge and belief. I know the fact that once I submit for registration with above infromation I will not be able to re-register myself and I will be fully responsible for the same. Once I submitted for Registration it is final.