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APPLICATION FORM FOR CONTRACT
APPOINTMENT OF DOCTORS ON FIXED PAY
“=== —_- Health Department, Government of Khyber Pakhtunkhwa
ATTACH Please attach photocopies of:
© CNIC ATTACH
¢ Domicile Passport size
* All Medical Degrees and Diplomas (MBBS/FCPS/other Specialization) (a Photos)
‘© Completion certificate of House Job
‘* PMC Registration
‘© Experience Certificates/Letters
NOTE Important things to note:
‘© Allinformation fields are mandatory; incomplete forms shall not
be accepted.
If any fields are irrelevant, mark as N/A
Please fill up the form in BLOCK letters
(Only one position can be applied for by each applicant)
Date Position Applied For
14-April-2022 GYNAECOLOGIST
First Name Last Name
UZMA BAKHTIAR
Gender Marital Status
Fathers Name ‘Spouse Name
BAKHTIAR AHMAD MUHAMMAD KAMRAN
Nationality Date of Birth Religion
PAKISTANI 1S-APRILA987 ISLAM
CNIC No. Domicile
17301-4611778-0 CHARSADDA,
Contact Information
Residence Phone No. Cell No.
0333-9291918 03159777690
Email Address
UBAKHTIAR@YAHOO.COM
Permanent Address (For Postal & Communication Please)
Country Province
PAKISTAN KHYBERPUKHTONKHWA
District City
PESHAWAR PESHAWAR
‘Address Details
6-D/3 PARK AVENUE ROAD UNIVERSITY TOWN PESHAWAR
1[Page P.T.OEducation (Highest Degree First)
Degree Institute «Obtained Grade %4Age Passing Yoar__—_—BoardUniversity
Fos HMC 2019 Psp
ees KGMC 1260/2000 stv 63% 2010 kMu
FSC JINNAH COLLEGE 9890/1100 Al 8090% 2004 BISEP
ssc PMs 706/850 AN 8305% 2002 BISEP
Professional Information
Type Professional Body Number Issue Date Expiry Date
Employment History (Most Recent First)
1. Organization Name Designation
MSF Medical Doctor Specialist Level 9
Email PhoneNo. Last Salary From To Date Leaving Reason
03425132014 250,000 01-Sep-2019
2. Organization Name Designation
HMC Medical Officer
Email PhoneNo. Last Salary From To Date Leaving Reason
091-9217140 90,000 M-DEC2018 13012021 EOL
3. Organization Name Designation
W.&C Hospital Rajjar Charsadda wMo
Email PhoneNo. Last Salary From To Date
93000 19-APRIL2018 10-DEC-2018_ TRANSFERED
4. Organization Name Designation
MERLIN wMo
Email PhoneNo. Last Salary From To Date Leaving Reason
80,000 Oct2013 FCPS TRAINING
5. Organization Name Designation
Email PhoneNo. Last Salary From To Date Leaving Reason
Are you currently employed?
Please (v) the box
Are you currently under any Govt. service?
Please (v) the box
21Page
Yes % NoO]
Yes) No Provide NocCan we approach your current employer?
Please (\) the box ves 4 No
Do you have any criminal record?
Please (1) the box Yes] Noy
If yes; please provide details
Do any of your relatives/acquaintances currently work in the KP Health Department?
Please (9) the box Yes No
If yes, please provide details
Name Designation Department
Dr Sumaira Bakhtiar Consultant LRH Peshawar
Languages
Read Write ‘Speak
English uw uw Zi
Urdu w 4 @
Pushto x Y
Oo oO Oo
References.
Name Organization/Department Designation Contact No. _ E-mai
DR SHAMSHAD BEGUM HMC Hop 03339965271, dr.shamshadkhan@yahoo.com
DR RUKHSANA KARIM HMC Asst Proffessor 0331-9278486 drrukhsanakarim@hotmail.com
1s (if any) Yes] Nom
If yes, please specify
| certify that the above information is correct to the best of my knowledge. In case of any wrong declaration,
wil be liable for any consequences including dismissal without notice.
2
Signature of Applicant: Date: _14-April-2022
3|Page P.T.OFOR OFFICIAL USE ONLY
Eligible: 7] Dated:
Not Eligible: 7]
Interviewed Yes] No[} Called on:
Application scrutinized by:
Interviewed by:
FREQUENTLY ASKED QUESTIONS (FAQs)
. 1am interested in applying for more than one position. Do | need to complete a separate
application for each position?
‘A. You can only apply for one position and submit one application. Multiple applications will result in a
disqualification,
Q. Am | required to follow up on my application?
‘A. No, once your application is received and found suitable for the position, you will be contacted by the
Department.
Q. How | will be informed if short listed?
A, Shortlisted candidates will be notified via office letter, and telephone.
. Does the Health Department give TA/DA to applicants?
‘A. No TADDA is permissible.
4|Page PLT.