Online Application Form
State Program Manager, National Health Mission, Uttar Pradesh

 

 

1. Personal Details:

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

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
Mode of Course
Passing
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. General Manager, June-2015 to June-2016] Key Responsibilities
[Mention atleast 3 key responsibilities]
Experience
(in Months)

From (mm/dd/yyyy):

To (mm/dd/yyyy):


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From (mm/dd/yyyy):

To (mm/dd/yyyy):

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From (mm/dd/yyyy):

To (mm/dd/yyyy):

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[+] Add More Work Experience (4) [Please click on (+) for giving more work experience details]

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[+] Add More Work Experience (14) [Please click on (+) for giving more work experience details]
[+] Add More Work Experience (15) [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 in managing public health programmes
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Experience in planning and budgeting
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Experience in monitoring and evaluation function of data systems, evaluation processes, impact studies etc.
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Experience in building capacities of teams on programme planning, implementing, monitoring and reporting for efficient programme management

 

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Experience in liaising and coordinating with State Government/ Central Government and with internal and external stakeholders
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6. Details of Present Compensation (In Rs.):

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

 

7. 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: 
Mobile:
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 by UPNHM regardless of the time elapsed before discovery.