Online Application Form
Cardiovascular Health Senior Treatment Supervisors, Vital Strategies
Punjab and Kerala



1. Personal Details:

Applicant's Name:
Father/Husband's Name: Date of Birth: (DD/MM/YY)
Gender: Mobile No.:
Email ID: Alternate Contact No.:

2. Address:

Correspondence/ Current Address with Pin Code: Permanent Address with Pin Code

3. Qualification Detials:

* Name of the Degree/ Diploma
Specialization & Principal Subjects
Name of University/ Institute
Month & Year
Marks (in %)


[+] Additional Qualification: [Please click on (+) sign if you have any other Degree/ Diploma]


4. Work Experience: [Please start with current/ most recent experience. If you have worked in more than one area/ post within the same organization, please enter details of the same separately]:

Name of Organisation Designation/ Title alongwith Duration [e.g. Health Officer, June-20015 to June-2016] Key Responsibilities
[Mention atleast 3 key responsibilities]
(in Months)

[Maximum Characters allowed: 300]
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[Maximum Characters allowed: 300]
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[Maximum Characters allowed: 300]
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[+] Add More Work Experience [Please click on (+) for giving more work experience details]

[+] Add More Work Experience [Please click on (+) for giving more work experience details]

5. Details of Relevant Experience:

Name of Organisation
(Including Years)
Exposure Area Details of Experience Possessed Experience
(in Months)
Experience of implementing public health projects/ programmes in association with the State Health Department/ Government
[Maximum Characters allowed: 300]
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Experience of having worked in the area of cardiovascular health and/or non-communicable diseases.
[Maximum Characters allowed: 300]
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Hands on’ experience of assisting in implementation of public health programmes such as proper functioning of health centres, availability of equipment and drug supplies, active case finding and retrieval, guiding health workers, etc.
[Maximum Characters allowed: 300]
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6. Details of Present Compensation (In Rs.):

a. Monthly Salary b. Monthly Allowances: (If any)

7. Computer Skill:

[Note: Applicants are likely to be tested in Excel and MS Office, to confirm their suitability]

(1) Proficiency in use of MS-Excel:
(2) Proficiency in use of MS-Office  

8. Language Proficiency:

Oral Proficiency Written Prociency
Excellent Satisfactory Excellent Satisfactory
Other (Please specify)

9. Location Preferences: (Please indicate names and your preferences for the state(s) you are applying for:)

State Preference:

State Preference 1st State Preference 2nd  

10. Driving Skills:

(1) Do you have a valid two-wheeler driving license?
(2) Do you have two years' experience of driving a two-wheeler?
(3) Issuing authority
(4) License number
(5) Driving License Issuing Date

11. Field Travel:

Please confirm your willingness and ability to travel upto about 15 days in a month, to different health facilities, within your assigned duty district?

12. References: (Please provide contact details of three references who have supervised you at work:)

  Referee One Referee Two Referee Three
Full Name:
Correspondence Address:
Professional Relationship with the referee: 
Email ID:

Declaration: I hereby declare that the information furnished above is true to the best of my knowledge and any misrepresentation, falsification or omission of information used to secure employment shall be grounds for rejection of this application and I would liable for legal action, also immediate discharge if I am employed as Cardiovascular Health Senior Treatment Supervisors regardless of the time elapsed before discovery..