GOVERNMENT OF WEST BENGALHEALTH & FAMILY WELFARE DEPARTMENT

NATIONAL HEALTH MISSION (NHM)GN -29, 1ST FLOOR, GRANTHAGAR BHAWAN,SWASTHYA BHAWAN PREMISES, SECTOR-V

SALT LAKE, BIDI-IANNAGAR, KOLKATA - 700 091.

~ 033 - 2353 - 0432,. 033 - 2357 - 7930,Email ID: spmu.nuhm@gmail.com; website: www.wbhealth.gov.in

No. HFW/NUHM-232/2016/-6L-tC} Dated: ~~.?2017

From : Commissioner, Health & Family Welfare &Add!. Mission Director, NHMGovernment of West Bengal

To CMOH,Asansol HD I Basirhat Health District I Birbhum I Burdwan I Cooch-Behar I DakshinDinajpur I Darjeeling (SMP)I Diamond Harbour HD /Hooghlv I Howrah I Jalpaiguri IJhargram HD /Malda I Murshidabad I Nadia I North 24 Parganas /Nandigrarn HDI PaYchimMedinipur I Purba Medinipur I Rampurhat HD I South 24 Parganas I Uttar Dinajpur

Sub:Provisional Admission of Trainees for ANM Courseunder NUHM for UPHCin different ULBs

Ref: Notification No. HFW/NUHM-232/2016/3826 dated 9.12.2016

With reference to above, an approved list containing ULBwise selected candidates for ANM trainingunder NUHM received from your end is enclosed. The namesof the Nursing Training Institutions (residential orNon-residential) where they will undergo such training have also been indicated ULB wise in the enclosedstatement (Annexure I).

2. You are requested to send the photocopies of all the concerned applications along with all relevantdocuments of selected candidates to the Training Institutions before commencement of the said training. Youare also requested to send intimation to the selected candidates to join the allotted Nursing TrainingInstitutions within the period from 1.6.2017 to 7.6.2017 (excluding holidays). The"class of ANM trainingcourse for 24 months duration will be started from 12.6.2017 in all the institutes.

A draft copy of the intimation letter is enclosed.

3. Failure to join the training course in time, or leaving the course midway for any reasons whatsoever,will result in the candidature being cancelled.

4. While sending the letter of admission to training course from the office of the CMOH, it should beclearly indicated that the admission is provisional and is subject to verification of original documents producedby the candidate in support of her age, residence and qualification.

After admission, if any candidate is found ineligible by any competent authority her candidature forundergoing training will liable to be cancelled and she will be terminated from the training course forthwith.Shewill also be liable to refund the stipend money paid to her.

.... ';

---------------------

-2-

S. The above selection for admission is provisional and subject to the decision or direction in differentcaseswhich may subsequently be received from Hon'ble Courts and competent authority.

6. Admission is also subject to medical fitness of the candidates for which they have to submit MedicalCertificate from a registered Medical Practitioner having at least a MBBSdegree in the prescribed format (copyenclosed). This Medical Certificate is to be kept in the Training Institutions.

7. The selected candidates are entitled to receive an amount of Rs.1000/- (RupeesOne thousand only)per month asstipend, fund for which will be sent to the respective training Institutions.

8. Accommodation will be provided to the trainees where the course is residential. NTSsthose arecompletely residential, the trainees will have to avail themselves of the accommodation.

9. The residential trainees will be provided free accommodation in the hostel. But they will have to makemessingarrangements at their own cost.

List of articles usually required to be brought by each trainee is enclosed.

fnclo -

1. Annexure 12. Specimen copy of Medical Certificate.3. Specimen copy of Model letter of the CMOHto the trainees.4. Specimen copy of Model letter to the Nursing Training Institution.S. List of articles to be brought by the trainees

commiSS~W) &Addl. Mission Director, NHM

No. HFW/NUHM-232/2016/6't't/I(II.)Copy forwarded for information and necessary action to:

1. Director of Health Services, West Bengal.2. State Family Welfare Officer, West Bengal, Swasthya Bhawan.3. Jt. DHS (Nursing), West Bengal.4. Registrar, West Bengal Nursing Council, 8, Lyons Range, Kolkata -700001.5. Commissioner, (Howrahl Durgapurl Asansoll Chandannagarl Siliguril Bidhannagar)

6. Executive Officer, (Baduria, Basirhat, Bolpur, Suri, Burdwan, Kalna, Katwa, Coochbehar,Balurghat, Diamond Harbour, Arambag, Baidyabati, Bansberia, Bhadreswar, Champdany,Dankuni, Hooghly Chinsurah, Konnagar, Rishra, Serampore, Uttarpara Kotrang, Uluberia,Jalpaiguri, Jhargram, English Bazar, Old MaIda, Jiaganj- Azimganj, Berhampur, Dhulian, Jangipur,Kandi, Chakdah, Gayeshpur, Haringhata, Kalyani, Krishnanagar, Nabadwip, Ranaghat, Santipur,Ashoknagar Kalyangarh, Bangaon, Baranagar, Barasat, Barrackpore, Bhatpara, Dumdum, Garulia,Habra, Halisahar, Kamarhati, Kanchrapara, Khardah, Madhyamgram, Naihati, New Barrackpore,North Barrackpore, North Dumdum, Panihati, South Dumdum, Titagarh, Ghatal, Kharagpur,

Dated:~;. ".2017

- 3 -

Medinipur, Contai, Haldia, Panskura, Rampurhat, Baruipur, Budge Budge, Maheshtala, RajpurSonarpur, Islampur, Kaliaganj, Raiganj)

7. PNO, District Hospital, Coochbehar8. PNO, District Hospital, North 24 Pgns9. PNO, Chittaranjan Seva Sadan, 37, SP Mukherjee Road, Kolkata - 700 02610. PNO, Howrah District HospitalII. Principal, Dr. RC. Mukherjee Memorial Health School, Singur, Hooghly.12. Superintendent, Kharagpur SD Hospital, Kharagpur, Paschim Medinipur13. Superintendent, Bolpur SD Hospital, Bolpur, Birbhum14. Superintendent, Vidyasagar S.G. Hospital, South 24 Pgns15. Accounts Officer, ID & BG Hospital, Beliaghata, Kolkata16. Principal I Teacher-in-Charge, NTS attached to District Hospital, Coochbehar I District Hospital, North

24 Pgns IChittaranjan Seva Sadanl Howrah District Hospital /Bolpur SD Hospital! Vidyasagar S.G.Hospital, South 24 Pgns I Kharagpur SD Hospital! ID & BG Hospital, Beliaghata, Kolkata

[He/She is requested to admit the trainees after verification of their original documents as well as medicalcertificate in the prescribed format by a Medical Practitioner having at least MBBS degree. He I She isrequested to send us the list of the candidates as soon admission is completed.]

A copy of the selection list as well as specimen copy of M.e. is enclosed for ready reference for 7 to 16only.

commis~ner (H&FW) &Addl. Mission Director, NHM

Name of the District: Paschim Mcdinipore

Annexure IIIProvisional Panel for engagement of ANM under NUHM C\)o, n€1\::vti- s c \.v_\ ' )

Representati~e of Oistl.i~t MagistratePaschim Medlnlpur

Name of the ULB: Midnaporc MunicipalityNo. Of required no.ofTrainee: I (SC Category)

\J

Details (10+2) Examination

SI. Name of theGuardian'S n301e Address with Phone Number Date of Birth Caste Marks obtained in

No Candidiatc Boardl Year of Total final examination Oft.of RankInstitute Passing Marks (best 5 subjects)marks

Dharma (Anandanagar )P.O-

I Mayna Hhunia Monisankar Dalai Midnapare P,S-Kotwali Dist-0802 1987 SC WBCHSE 2004 1000 478 47,8 1stPaschim Midnaporel-in-

721101 Mob No-9609391996

REMARKS

Selected

..._----------------------------------- _-, -,

Signature of the Dy.CMOH-!,with seal & Date: Signature of the QJ.CMOH, with seal &Date:

'b1'~'-~&-Jl.~:1~lt'lSignature of the Hon'ble

Chair persoin of therecruitment committee ofthe District with seal &:

Date

Chairman 'I' P.. nt ComIT11Ie~Recrultme hOmMedinipur

DH & fWS, Pase I

Annexure IIIProvisional Panel for engagement of ANM under NUHM - (Panel for - UR Category)

the District: Paschim Medinipore

oftbe Ul.B: Kharagpur Municipality

Of required no.of Trainee: 8 (UR - 4, SC -2, ST-I, OBC-A - I)

Details (10+2) Examination

81. Name of theGuardian's name Address with Phone Number Date of Birth Caste Marks obtained ill

No Candidiate Board! Year of Total Rank Remarksfinal examination %ofmarks

Institute Passing Marks(best 5 subjects)

At-Hijli Co-Opereative society .Ward No-34 , P.O-

I Sonia Kar Kamal Krishna Hijli Co-operative, P.S-Kharagpur Town, Dist-18.08.1989 General WBCHSE 2008 500 291 58.2 1st Selected

Kar, Paschim Midnapore, Pin-721306, Mobile No.-9609784649

Kharida, Kumarpara, Near Suvadra Press.Ward No.9,2 Piyali Roy Jaideb Roy, Kharagpur ,Paschim Medinipore,Pin-72130 I, Mobile 22.11.1988 General WBCHSE 2006 1000 558 55.8 2nd Selected

No. - 9733417547

486f375,Ranikuthi Sanjoal,P.O-Kharagpur, Dist-3 Mithu Pal (Dey) Saiba1Pal Paschim Midnapore, Pin-721301, Mobile No. 13011988 General WBCHSE 2005 1000 529 52.~ 3rd Selected

9474712320

Mumntu Hhunya At - Ararnbati, P.O- Nimpura, P.S- Kharagpur (T),4 (MaIlJal) Akulesh Mandai Dist-Paschim Midnapore, Pin- 721304, Mobile No. - 26.02.1987 General WBCHSE 2004 1000 501 50.1 4th Selected

9932657373

At. - Sukantanagar, Ward No-34 P.O- Talbagicha5 Tania Das Sumanta Das (Kharagpur), Dist-Paschim Midnapore , Pin-72 1306, 23.02,1987 General WBCHSE 2005 1000 487 48.7 5th Waiting-I

Mobile No. - 9134921318

Mallika Pariya Nitai Chandra At- Nimpura Natunpalli, P.O- Nirnpura, P.S-

6Pariya Kharagpurt'T), Dist-Paschim Midnapore, Pin-721304,

27.12.1989 General WBCHSE 2007 500 240 48 6th Waiting-2Mobile No. - 9679774166

Sangita RoyAt.- Koushlya(near Vidyasagar bank), P 0- Kharagpur,

7 (Thapa) Anil Thapa Dist-Paschim Midnapore, Pin- 72130 I, Mobile No. - 15041986 General WBCHSE 2004 1000 456 45.6 7th Waitiog-38001602963 .>

,~;~

I Oi-'('( .: :,~~-: ~~(clJ~". "('(' ""\ •... <J 'V ~t.1~3' ~)~ 0c.:.~".j,)-j\ ..-i.'. ,.:;:....' o- Signat e of the Signature of the Hon'ble Chai persoin,.' );-...::i,\Signature of Rcjll'esfliiatlve of the ;,: Mayor,MC/Cahirperson, Signature of Dy.CMOH-1with seal & ~,CMOH, with seal of the recruitment committe of the

District Magistrate with seal & Dale: Signat . . .:. . Municipality date & Date: District with seal & Datep '~_:1':\Z,'.~:t ,','~~'/.:; '~.~~.~'~':'.l.:~?:!~';:'

R8nresentativB of District Magistrate, PISChim Madinipur ,

:",;;/ ··.'iChairman

Recruitment CommitteeDH & FWS, Paschim Medinipur

Details (10+2) Examination

."of the Guardian's name Address with Phone Number Date of Birth Caste Marks obtained in Rank Remarksandidiate Board! Year of Totalfinal examination %ofmarksInstitute Passing Marks(best 5 subjects)

Lakshmi Rani Gora Chand At-Rarnnagar (Bara Ayrna), Ward No-31,P.O-Nimpura,8 P.S-Kharagpur (Town), Dist-Paschim Midnapore, Pin- 0901.1980 S1 WBCROS 2010 1000 450 45 8th Waiting-4Baskey(Mandi) Baskey

721304, Mobile No. - 9378196069

9 Peali Rudra Dev At - Talbagicha(W), Kharagpur, Dist-paschim23.03 1981 SC WBCHSE 2001 1000 438 43.8 Waiting-5Biswas(Sarkar) Biswas Medinipur, Pin-721306, Mobile No. - 9800002268 9th

AI.- North lnda, Kalamandir Near Inda boys school,10 Bidisha Pal Pritarn Pal P.O-Inda, Dist-Paschim Midnapore, Pin-721305, 12041987 General WBCHSE 2006 1000 416 41.6 10th Waiting-6

Mobile No. - 9932251309

At-New Development (near Koushlya School) P.O-II Sonali Pal Maity Tushar Maity Kharagpur Dist-Paschim Medinipore Pin-721301, 22.04.1987 General WBCHSE 2004 1000 384 38.4 11th Waiting-7

Mobile No. - 9474712320

Ramesh Chandra At-Jhapetapur , Kasaikati.Ward No-28, Kharagpur,11 PUllilSingh

Singh Dist-Paschim Midnapore, Pin-72130 I, Mobile No. 04.06.1988 S.T WBCHSE 2007 500 187 37.4 12th Wailing-87908084012

Somnath Sarkar At.- Talbagicha Ward No.35 P.O- Talbagicha, P.S-II Plv:dll S;Irkar Kharagpur (Local) Dist-Paschirn Midnapore Pil1- L 11986 General WBCI-ISE 2006 1000 368 36.8 13th Waiting-9(rather)

721306, Mobile No. - 8944876655t---- _ ... /)

'.

~

~JP,'~lr~\~ ~~,~

~

. .' ::{/. ~~'., "f>-'_~ , 'V~cc.,·"'~ Signature of the Signature of the Signature of the Hon'ble Chair persoinSignature of Representative of Ihe .' ....Mayor,MCICahirperson, Signature of Dy.CMOH-1with seal & Dy.CMOH, with seal of the recruitment committee of theDistrict I\illoist.-ate with seal & Date: Signature mit ie D e: Municipality date & Date: District with seal& Date

F' l·j.:J.s,~.. :' !~-.:f·).:. ~ .. ;;:r.

Representative of District MagistratePaschim Medinipur

t.""".tlJ.r: Ii'\: ~f:;}jW.:~}O:iC?i'

ChairmanRecruitment Committee

DH & FWS. Paschim Medinipur

,./,

Annexure III---"--------------------------------------------------------~ "-,

Name of the ULB: Kharagpur Municipality

Ramesh Chandra At-Jhapetapur , Kasaikati, Ward No-28,Kharagpur, Dist-Paschim Midnapore, Pin­

Singh72130 I,Mobile No, - 7908084012

2 Putul Singh 04.06.1988 S.T

Provisional Panel for engagement of ANM under NUHM - ( Panel for - ST Category)------------------------------------------------~~~--~------------~~~~~~--~-------~----~~~~~~~-------------------------,--.me of the District: Paschim Medinipore

No, Of required no.of Trainee: 8 (UR - 4, SC -2, ST-!, OBC-A - 1)

2nd Waiting - I

Details (10+2) Examination

SI. Name of theGuardian's name Address with Phone Number Date of Birth Caste Marks obtained in Rank RemarksNo Candidiate Board! Year of Total

final examination %ofmarksInstitute Passing Marks

(best 5 subj eels)

At-Rarnnagar (Bara Ayma), Ward No-

I Lakshrni Rani Gora Chand 31,P.O-Nimpura, P.S-Kharagpur (Town),09.01.1980 S.T WBCROS 2010 1000 450 45 15t SelectedBaskey(Mandi) Baskey Dist-Paschim Midnapore, Pin-721304,

Mobile No. - 9378196069

,\

-;:::;.~:,;,'')Signature of Representative of theDistrict Magistrate with seal & Date:

V)rA~Y- "~Irv ~'"-'-~\~'\;;-/0 U V Q '1~Signature of t~ 'Signature of the Hon'ble Chair

Signature of Dy.CMOH-1 with seal ~CMOH, with seal persoin of the recruitment committee& date & Date: of the District with seal & Date

WBCHSE 2007 500 187 37.4

Chairman ., t Committee

Recrultmen h'm MedinipurDH & FWS, Pase I

/

J\\t ~,aJZ' If"1~ ;?-

Signature of theMilyor,MC/Cahirperson,

Municipality

. . tM gi-nalHR8~!CSentative of Dlst~l~ antsPaschim Medlmpur

--Provisional Panel for engagement of ANM under NORM (Panel for -OBC-A CategoJi)

.me of the District: Paschirn Medinipore

,\)ame of the ULB: Kharagpur Municipality

No, Of required no.of Trainee: 8 (UR - 4, SC -2, ST-l, OBC-A - 1)

Details (10+2) Examination

Sl. Name of theGuardian's name Address with Phone Number Date of Birth Marks obtained in Rank RemarksCaste Board/ Year of TotalNo Candidiate

final examination %ofmarksInstitute Passing Marks(best 5 subjects)

I No Eligible candidate found for OBC-A Category; _D '"() / /

-:~<'7 ,If ~.,~,{ :\p',Jv~~\O ~_

- -- /~1,tJ--~v C)_.~ ~, \ ,_ .. ~r "J}-\~161\ ~ture of the Hon'blc 'hair\ " '(,'''':;'

.,~

') Signatu~ of theSignature of Representllti;'e of the .s--; Signature 0 persoin of the recruitment,- _

Mayor,MC/Cahil'person, Signature of Dy,CMOH-[ with seal _,C]\.IOH, with se I committee of the Distrlct with sealDistrict Magistrate with seal & Date: Signature of the OPHNO with seal & Date: Municipality & date & Date: & Date

.;::

Annexure III,

, •• n'IS\late_D' tllct ,,,a,,'~e01 ISHepresentatl h'm t-JiedinipUf{'aSCII'

ChairmanRecruitment Commitlee,

Dr! & FWS. Paschim iVledlnlpur

Provisional Panel for engagement of ANM under NUHM ( Panel for - SC Category).me of the District: Paschim Medinipore

,'-lameof the ULB: Kharagpur Municipality

No. Of required no.of Trainee: 8 (UR - 4, SC -2, ST-I, OBC-A - I)

Details (10+2) Examination

Sl. Name of theGuardian's name Address with Phone Number Date of Birth Caste Marks obtained in Rank RemarksNo Candidiate Board/ Year of Total

final examination %ofmarksInstitute Passing Marks(best 5 subjects)

Peali RudraDev At - Talbagicha(W), Kharagpur, Dist-1 paschimMedinipur, Pin-72 1306, Mobile 23.03.1981 S.C WBCHSE 2001 1000 438 43.8 lst SelectedBiswas(Sarkar) Biswas

No. - 9800002268

2 No Eligible candidate found for another post for SC Category.c:

t).'v.ll~~W--

Sig~.\\C

lJ-/V ~"l;J ~~C-'$' ~ :/r';'\ r . ' L. ): ~..';"'. -_;;o_;'" ) , Signature of the Hon'ble Chair

;.;.;:;'''1.

// Signature of the persoinof the recruitmentSignature of Representative of the Mayor,MCICahirperson, Signature ofDy.CMOH·Iwithseal _.CMOH, with seal committeeof the Districtwith sealDistrict M:tgistrate with seal & Date: Sign~ofthe DPHN9~ith seal& Date: Municipality & date & Date: & Date

-'.p .... .,' ',man ,-

Annexure III

I.....

Representative ot Dist~i~tMagistrate. Paschim Medmlpur

/

Annexure IIIProvisional Panel for engagement of ANM under NUHM - (Panel for SC Category)

Name ofthe District: PaschimMedinipore

Name of the ULB: Ghatal Municipality \

No. Of required no.of Trainee: 02 CUR-I,SC-I)

Details (10+2) Examination

SI.N Name of theGuardian's name Address with Phone Number Date of Birth Caste Marks obtained in

0 Candidiate Board/Institute Year of Total final examinationO/oof

Rank REMARKSPassing Marks (best 5 subjects) marks

At-Krishnanagar P.O+P.S-

I Sabita Pandit (Dobey) Kashinath Dobey Ghatal, Dist-Paschim 29.07.1983 SC WBCHSE 2003 1000 390 39 1st SelectedMidnapore, Pin-n1212 Mob -8001734060

~ ,j

~

t3 ,;_tS- IT./} cJ .., Oti-.-oifh /7

~~ lh'l~~""62.. 3>. 02.. ' 11~ ~~YO Pt~:"

.,-_- 1\ V'-: ..ri:~,;;:,<~.'j V' Signature of the Signature of the Hon'ble Chair persoin of the

Si~"ature of Representative of the District "lSfg,lature of the DPHNO with seal Mayor,MC/Cahirpersoo, Signature of Dy.CMOH-[ with seal & "CMOH,with recruitment committee of the District with seal &Magistrate with seal & Date:

.. ····r···:"." .. ,,"~.,'"seal & Date:& Date: Municipality date Date

i .T;;':::.:;rnY;;TL, ~.' -R?pre~entative of District Magistrate

Paschim Medinipur," ..: ~:.

. ):ii> ..S;.;,;,(~ll.~~(~t}l.t.0~~~,-;l.!prua)..~ ''.~: "

Annexure IIIProvisional Panel for engagement of ANM under NUHM - (Panel for UR Category)

Name of the District: Paschim MediniporeName of the ULB:Ghatal MunicipalityNo. Of required no.of Trainee: 02 (UR-I,Se-I)

Details (10+2) Examination

Guardian's nameAddress with Phone

Date of Birth Marks obtained inSI.No Name of the Candidiate Caste Yearof Total %ofNumber Boa rdfl nstitute Passing Marksfinal examination

marksRank REMARKS

(best 5 subjects)

At-Kushpata (Durabhaspally) Ward

1 Karuna Gowsarni Rajkumar GoswamiNo-16,P.O+P.S=GhataIDist-

13031988 General WBCHSE 2006 1000 623 62.3 1st SelectedPaschim MidnaporePin- 721212 Mob-

9735770552

At- Argora P.O- Ghatal P.S- Ghatal2 Romi Das Sanjoy Das Dist-Paschirn Midnapore Pin- 08.02.1989 General WBCHSE 2008 500 276 55.2 2nd Waiting-I

721212 Mob· 9851691218

At-Garpratap Nagar, PO+P.S·Ghatal3 Shibarn Dhara Gokul Chandra Ohara Dist-paschim Medinipur Pin-72 t 212 01.10.1989 General WBCHSE 2008 500 255 51 3rd Waiting-2

Mob - 9609904010

At-Kushpata Ward No-16,

<1 Palgur.iGharan Khamrai) Atanu KharnraiP.O+P.S=GhalaJ Dist-Paschim

23.1.1987 General WBCHSE 2004 1000 452 45.2 4th Waiting- JMidnaporePin-721212 Mob·

9933128312

',A At-Krishnanagar P.O+P.S-Ghalaiii, Dist-Paschim Waiting-45 Sebna Pandil('Dobey) Kashinath Dobey MidnaporePin· 721212 Mob·29.07.1983 SC WBCHSE 2003 1000 390 39 5th

8001734060 / r-.

~

13~cJ...·~~1

~~

lh' e· <)i\~ 2...3~'OL.!:r (;~I>J.-.f ~~. I~'<5~5::>,_".;.~"t).... . ,;.<, ); .~, .,"'\~:..".".~..~<_"t:f;~ Signature of the ..--- Signalure of the Hon'ble Chair persoin of the

Signature of Representative of the District..? Mayor,MC/Cahirperson, Signatu e of Dy.CMOH-I with seal & recruitment committee of the District with seal &

Magistrate with seal & Date: & 031.::,.:" ',.:,",\',Cl'rc ':"j;: ;';,;1. 1."3 \,(~H:- . Municipality date liIIlCMO ,wth ' Date.. em

•'",.~~ !Chalrm ,

. 'tment Cornmn.(ee ,ReFCWIUSI Paschim Medlnlpur

OH & 'Representative of Oistr.i~tMagistrateraschim Medlnlpur

"\ . .'

Annexure I

ULB wise Number of ANM & Training Institute

required Number selected81. District ULB of trainee for 1st number of Training Institute Residentiall Non-No. phase trainee residential

1 PaschimMedinipur Ghatal 2 2 KharagpLJr.$DHospital Residential

2 PaschimMedinipur Kharagpur 8 6 .... KharagpUrSD;Hospita I ResidentiaI

3 PaschimMedinipur Medinipur 1 1 1\ Kharagpur SDHospita I Residential

Medical Certificate in case of appointment of candidates underWest Bengal state Health & Family Welfare Somiti

Name ot Ihe candidate in tull (in block letters)

Height (without shoe)

Weiglll

Cm.

Kg.

"1 hereby certltv that I hove examined Sri/Smt. " , a

.candidate for employment in tile Wesl Bengal State Health & Family Welfare Samiti. and can'l

discover thaI Sri/Smt , ,.., " ,......... has any disease.

(communicable or otherwise) constitutional weakness or bodily infirmity,

except. " .." " ,,"

I do nol consider this a disqualification for employment in the office of Slate Somiti.

Sri/Srnt 's age is.according to hisown statement. Years,

and by.appearance about. " ""." " yeors".

a. General Development Good/Fair/ Average/Poor

b Vision Righi eye: Leff eye:

i. Uncorrected/Naked eye

ii. Correcled

iii. Nature and degree

c. Teeth: d. Hearing e. Blood pressure:

t. Lung: g. Heart h. Liver

i. Spleen

j. Hernia (present or absent)

k. Hydroeceles (present or absenf)

I. • Urine i. Specific Gravity Ii. Albumin iii. Sugar

rn. Identification marks

n. TheCandidate is

P.~eIoil

Doted:

Signature of Candidate

Attested

. 1

i. Fit

ii. Unfit on account of

iii. Temporarily unfit on account of

Signature of the Medical Pllli:<titioner

Name

Degree

Regn. No.(Seal)

Government of West BengalOffice of the CMOH .

District .No. Date:

ToSmt ..Address .

MunicipalitylMunicipal Corporation .District ..

Sub: Provisional admission for training for ANM Course under NUHM

With reference to above subject, I am to inform you that you are selected for 2 years

ANM training course under NUHM. You are therefore requested to report to the Principal /

Sister Tutor In-Charge or the Officer-in-Charge of the

Nursing Training School positively within

........................ (excluding holidays) .

Failure to join in the training course in time, or leaving the course midway for any

reasons whatsoever, will result in the candidature being cancelled.

At the time of admission you should bring Medical Certificate in the enclosed format

from a registered Medical Practitioner having at least MBBS degree. You should also bring

original certificates in support of the age, educational qualifications, caste certificate and

residential status, which will be returned to you after verification.

Venue of training centre will not be changed under any circumstance.

All trainees are entitled to receive a sum of Rs. 1000/- (Rupees One thousand only) per

month as stipend. Accommodation will be provided to the trainees where the course is

residential. NTS, those are completely residential, the trainees will have to avail themselves of

the accommodation compulsorily. The residential trainees will be provided free accommodation

in the hostel. But they will have to make messing arrangements at their own cost.

List of articles usually required for the residential trainee, which will have to bring by

each trainee is enclosed.

After admission, if you are found ineligible by any competent authority, your candidature

for undergoing training will be liable to be cancelled and you will be terminated from the

training course forthwith. In that case, you will also be liable to refund the stipend money paid

to you.

Selection / admission is provisional subject to decision of any court of law in future in the

matter and verification of original documents as to age, residence, caste certificate and

qualification as well as medical fitness. It is reiterated that selection / admission will be

summarily rejected / cancelled if any of the documents produced by you is found to be notgenuine.

CMOH, District .

Government of West BengalOffice of the CMOH .

District .

No. Date:

ToThe {In-charge of NTS).......................................... {Name of the Nursing Training Institution)

Sub: Admission of trainees for ANMCourse under NUHMfor theUPHC of the ULB

Sir / Madam,

With reference to the above subject I am sending the photocopies of

the applications alongwith all relevant papers of the selected candidates of

Municipality/ Municipal Corporation for taking further

necessary action from your end in terms of letter no .

dated from the Department of Health & Family Welfare, West

Bengal.

Yours faithfully,

CMOH, District

A.N.M. TRAINING UNDER NUHM

LIST OF ARTICLES REQUIRED TO BE BROUGHT BY EACH TRAINEE

FOR RESIDENTIAL STUDENTS

SL No. Materials Quantity1 TRUNK WITH LOCK 1 PC2 MATIRESS SINGLE 1 PC3 PILLOW 1 PC4 MOSQUITO NET 1 PC5 BED SHEET 1 PC6 BED COVER 1 PC

7 BLANKET 1 PC8 MUG 1 PC9 TIFFIN CARRIER/BOX 1 PC10 RICE PLATE 1 PC11 GLASS 1 PC12 BATI 2 PC13 SPOON 2 PC14 BLACK HAIRNET 1 PC15 PERSONAL TOWEL (TOOTHBRUSH,PASTE) 1 PC16 EXTRA LOCK & KEY(FOR ROOM) 1 PC17 B.P. APPARATUS TO BE PURCHASED LATER

ON18 STETHOSCOPE DO19 MONEY (AT LEAST RS.5000/) FOR UNIFORM,BOOKS,

B.P. APPARATUS,STETHOSCOPE etc. - TOKEPT WITH THE STUDENT

20 TORCH 1 PC21 UMBRELLA 1 PC22 PERSONAL DRESSES AS PER NEED23 PENCIL BOX ERASER,PENCIL, PEN,

SCISSOR, RED BLUE PEN24 NOTE BOOKS 8- (No.4-8)25 White paper 4 DISTA

------------------------------------- . --

A.N.M. TRAINING UNDER NUHM

LIST OF ARTICLES REQUIRED TO BE BROUGHT BY EACH TRAINEE

FOR NON-RESIDENTIAL STUDENTS

SL No. Materials Quantity1 BLACK HAIRNET 1 PC2 B.P. APPARATUS TO BE PURCHASED LATER ON3 STETHOSCOPE DO4 MONEY (AT LEAST RS.5000/) FOR UNIFORM,BOOKS,B.P.

APPARATUS, STETHOSCOPE,etc - TO KEPT WITH THE

STUDENT5 TORCH 1 PC6 UMBRELLA 1 PC7 PENCIL BOX ERASER,PENCIL, PEN, SCISSOR,

RED BLUE PEN8 NOTE BOOKS 8- (No.4-8)9 White paper 4DISTA