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APPLICATION FOR THE POST OF CIVIL ASSISTANT SURGEONS/DENTAL ASSISTANT SURGEONS IN DIRECTOR OF PUBLIC HEALTH & FAMILY WELFARE, ANDHRA PRADESH: HYDERABAD Latest Passport Size Photo Attested by Gazetted Officer

Applica i!" R#$i% &a i!" N!'

()*+),,)-

Medical Council Registration Number Post Applied !or Surname Gender !ather#s Name Category

59395 CAS

ate of 31-01-2008 Registration

KAKARLAMUDI Name Male


VENKATA RATNAM

KIRAN KUMAR ate Of "irth 16-07-1983 Hindu


Percentage of isability

Religion

SC
%f &es Category

Are you a person $ith no isability 'hether belongs to ()* no Ser+ice Men Category
ADDRESS

ANDHRA PRADESH ,ehsil- "loc.- Mandal TENA!" 5-2%-50&1'(&o 0ouse No )*SR"N"+ASA RA,' City TENA!"
State
SCHOOL DETAILS

istrict

GUNTUR

/illage-'ard TENA!"#U$ PADD"S,N Street PET' "THANAGAR Pincode 522201 State


ANDHRA PRADESH ANDHRA PRADESH ANDHRA PRADESH

Class %/ / /%

Name of the School


MARUTH" +"D-A N")ETAN MARUTH" +"D-A N")ETAN MARUTH" +"D-A

Place
TENA!" 1992

&ear of Passing

istrict
GUNTUR

TENA!" TENA!"

1993 199%

GUNTUR

GUNTUR

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/%% /%%% %1 1

N")ETAN ST*PAU!S H"GH SCH,,! ST*PAU!S H"GH SCH,,! ST*PAU!S H"GH SCH,,! ST*PAU!S H"GH SCH,,!

PH"RANG"PURAM 1995

ANDHRA PRADESH ANDHRA PRADESH ANDHRA PRADESH ANDHRA PRADESH

GUNTUR

PH"RANG"PURAM 1996

GUNTUR

PH"RANG"PURAM 1997

GUNTUR

PH"RANG"PURAM 1998

GUNTUR

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MEDICAL EDUCATION DETAILS

Name Of Course

Name Of College-2ni+ersity

Ma)imum Mar.s &ear of Mar.s in Obtained all in all Passing &ears &ears

M11S
PG DETAILS

GUNTUR MED"CA! 2006 C,!!EGE'DR*NTRUHS

2%50

1%58

Name Of Course

Name Of College-2ni+ersity

Sum of Sum of Ma)imum Mar.s Mar.s in Obtained &ear of in all all &ears Passing &ears of of 3ualifying 3ualifying ()am ()am

CONTRACT DETAILS

Name of %nstitute

'or.ed 2nder

PHC')AR!APA!EM PHC'"NTURU PHC +"S8ES8ARAM


INTERNSHIP DETAILS

DMH, DMH, DMH,

Period !rom Period ,o 4dd* Place 4dd*mm*yyyy5 mm*yyyy5 03-0%-2012 12-07-2012 Ru2al 13-07-2012 19-05-2013 Ru2al

20-05-2013

25-09-2013 Ru2al

%nternship Period !rom


DD DETAILS

05-01-2007

Period ,o 0%-01-2008

Number "an. Name

ate "ranch Name

DECLARATION %6 r7 .A.ARLAMUDI .IRAN .UMAR S-o6 -o VEN.ATA RATNAM Certify that the particulars gi+en abo+e are correct to the best of my .no$ledge and belief7 % also agree that in the e+ent of any of the particulars furnished in my application being found to be incorrect or false at a later date my appointment $ill be cancelled summarily7 %6 r7 .A.ARLAMUDI .IRAN .UMAR S-o6 -o /(N8A,A RA,NAM $ill abide by the rules under $hich % may be appointed in regular ser+ice6 if selected7 % $ill 9oin in the place $here % am posted $ith in the stipulated time specified by the authorities failing $hich % forefeit my rights to be appointed in this recruitment7

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S%GNA,2R( O! ,0( APPL%CAN, 9o2 ,//i(e U:e ,nl;

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