aiims

All India Institute of Medical SciencesAnsari Nagar, New Delhi - 110608Recruitment Exam - 2015

Registration Slip - Recruitment to the Post of Group A ( Non Faculty), B & C, AIIMS, New Delhi - 20151) Application No.: 5421049074 20) Correspondence Address NEAR OF SHARDA AL

NIKETAN V POST DEGANAJN DIST NAGAUR, DEGANAJN

2) Application Date 12 Jun 2015

3) Applied Post Sister Grade-II

4) Applicant's Name MUKESH SONI 20.a) State/Country Rajasthan

5) Date of Birth 11 Mar 1992 20.b) Pin Code 341503

6) Father's Name MAHAVEER PRASAD SONI 21) Permanent Address NEAR OF SHARDA ALNIKETAN V POST DEGANAJN DIST NAGAUR, DEGANAJN

7) Mother's Name SHOBHA DEVI

8) Gender Male

9) Category: OBC (Non Creamy Layer) 21.a) State/Country Rajasthan

10) Nationality: Indian 21.b) Pin Code 341503

11)State of Domicile: Rajasthan 22) Phone No. -

12)Physically Handicapped: No 23) Mobile No. 941392902912.a) Physically Handicapped(Option) : 24) Id Proof. Aadhaar Card

12.b)Physically Handicapped( %) 25) Id Proof Number 841937104823

13) Are you a GovernmentEmployee ? No 26) Fax No. -

13. a) Type of Job Status: 27) Email Id soni.pawan1988@gmail.com

13.b) Date of Appointment: NA 28) Payment Details

13.c) Present Position held: 28.a) Mode of Payment Through Debit/Credit Card14.) Are you a AIIMSEmployee ? No 28.b) Payment Type Registration

14.a) Joining Date: NA 28.c) Payment Date 12 Jun 2015

14.b) Ending Date: NA 28.d) Branch Code

14.c) Post Name: 29) Journal Number

14.d) Department Name: 30) Internship Details

14.e) Job Type AIIMS: 0 30.a) InternshipStatus NA15.) Are you anEx-Serviceman ? No 30.b) Start Date NA

15.a) Service In: 30.c) End Date NA

15.b) Start Date: NA 30.d) Days

15.c) End Date: NA31. Technical competence tohandle sophisticatedinstruments detail

NA

15.d) Service Duration:

16)University Name: RAJASTHAN UNIVERSITY OF HEALTHSCIENCE

17)State Name: Rajasthan

18)Qualifying Exam - |: B.Sc. in Nursing

19)Qualifying Exam - ||:

32.) Academic/Technical Qualification

AIIMS http://recruitgpabc.aiimsexams.org/PrintForm.aspx

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S.No.

ExaminationPassed

DegreeName College/Institute Name Subject/Specialization Enrollment

DatePassingDate

Aggregate % of markssecured

1 B.Sc. in Nursing BSCNURSING

SIDDHARTH INSTITUTE OFNURSING ALL SUBJECTS 16 Sep 2010 12 May

2015 74.0000

33.) Registration Details

Registration State Registration Year Registration No. Registration Expiry

Rajasthan 2010 RN86554,RM77338 2019

37.) Photo of Candidate38.) Signature ofCandidate

UNDERTAKING/DECLARATION:I have read and understand the Advertisement & detailed information on website and satisfied theeligibility in all respect for the post(s) before 16-06-2015.I hereby declare that the information furnished by me in the Application Form iscorrect and nothing has been concealed. In case any information furnished by me is found to be false, my candidature/registration/admission/service may be cancelled/terminated. I have not concealed any information. I realise that if any information furnished herein isfound to be incorrect or untrue; I shall be liable to civil/criminal prosecution and also forgo my claim to the admission/appointment in theInstitute.

AIIMS http://recruitgpabc.aiimsexams.org/PrintForm.aspx

2 of 2 12-06-2015 16:06