Online Application Form
Vaccine Logistics and Cold Chain Managers (VCCMs)

 

 

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
Passing 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. Immunizaion Officer, June-20015 to June-2016] Key Responsibilities
[Mention atleast 3 key responsibilities]
Experience
(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 in IT related projects
[Maximum Characters allowed: 300]
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Experience in supply chain related projects
[Maximum Characters allowed: 300]
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Experience in public health/ health care/ vaccine management or cold chain management
[Maximum Characters allowed: 300]
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Involvement with immunization programmes
[Maximum Characters allowed: 300]
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Training and capacity building of subordinate staff
[Maximum Characters allowed: 300]
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Undertaking frequent field visits to monitor status of project implementation and suggest and oversee course corrections by field staff
[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:

Application
(1) Knowledge of Windows Operating System & Internet:  
(2) Proficiency in use of MS-Office  
a. Excel  
b. Word and  
c. Powerpoint  

8. Language Proficiency:

Language Oral Proficiency Written Prociency
Excellent Satisfactory Excellent Satisfactory
English
Hindi/Regional Language
Other (Please specify)

9. Driving Skills:

(1) Do you have a valid two-wheeler driving license?
(2) Issuing authority
(3) License number

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

State Preference:

State Preference District Preference 1st District Preference 2nd

 

11. 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:

12. Compensation Offered: Gross compensation offered for the position shall be Rs. 22,000/- per month plus Rs. 5,000/- per month towards reimbursement of actual travel costs incurred within the district.

Please certify that above mentioned offer is acceptable to you:
13. Joining Documents: Police Verification, Medical Fitness Certificate and Demand Draft of 22,000/ as security deposit against company assets will be submitted as a pre-requisite to joining.

Certification: I certify that to the best of my knowledge and belief, the details submitted by me correctly describe my qualification, experience and other information, as requested by SAMS.