apply online – BIMS- A Medical College

Bishnupur Public Institute of Medical Science (Proposed)

Online Application

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Step 1 of 2

Application for the position & Department *

Position Applied As *

Name *

Email *

Phone *

Fathers Name *

Mothers Name *

Sex *

Date Of Birth *//

Age as on 1st July, 2021:

Place of Birth *

Address for Correspondence *

City/Town *

State / Union Territory *

Pin: *

Mobile No. *

Phone No.: Residence

Pan No *

AADHAR NO. (Optional)

Marital Status: *

Whether any relative is / was employed in the Institute: *

If yes, details of relationship and employment (Name, Designation, Department / Section and place of working):

Whether belong to S.C./ S.T.

Phone