7/11/2014 RGUKT Application Form

http://rgu-pm-application.appspot.com/formpreview?id=RGU2014PFA0003101 1/2
Application for The Post of Assistant Placement Officer/ Student Counselor/ Trainers in Performing Arts/Staff Nurse/ Pharmacist/
Medical Lab Technician/ Psychologist cum Counselor
Created on: Fri Jul 11 17:44:14 IST 2014
A copy of this printout along with the following attachments :
Copy of all relevant certificates
Copy of Caste reservation certificate (if eligible)
Copy of PH reservation certificate (if eligible)
should be posted to :
The Registrar,
Rajiv Gandhi University of Knowledge Technologies,
Vindya-C4, IIIT-Hyderabad campus. Gachibowli, Hyderabad-500032
Full Name : BIJINEMULA AMEEDA
Post Applied for :
Staff Nurse
Application Number : RGU2014PFA0003101
Personal Details
Full Name: BIJINEMULA AMEEDA
Email ID : shafi.bhava4@gmail.com
Mobile Number : 9704884983
Date of Birth : 01 - June - 1988
Age as on 31.12.2014 : 26 years, 6 months, 30 days
Nationality : Indian
Gender : F
Father's Name : B. Babu Sab
Mother's Name : B. Mahabhubjan
Mailing Address
House number : 1-318
Street/Colony : Big water tank
Village/Town : Angallu
City : Madana Palle
Country : India
State : Andhra Pradesh
District : Chittoor
Pincode : 517 325
Permanent Address
House number : 1-318
Street/Colony : Big water tank
Village/Town : Angallu
City : Madana Palle
Country : India
State : Andhra Pradesh
District : Chittoor
Pincode : 517 325
Community
Caste : BC-B
PH Category : No
Educational Qualifications
Qualifica
Name of
Subject/
Name of
the Year of
Marks/
Max.
7/11/2014 RGUKT Application Form
http://rgu-pm-application.appspot.com/formpreview?id=RGU2014PFA0003101 2/2
tion the
Course
Branch Universit
y/ Board
Passing CGPA
Obtained
Marks Division
GRADUAT
ION
B.Sc Nursing
Dr. NTR
Universit
y of
Health
Sciences
, A.P
2009 1802 2650 First
INTER Bi.P.C
Board of
Interme
diate
Educatio
n, A.P
2005 716 1000 First
SSC
Board of
Seconda
ry
Educatio
n, A.P
2003 472 600 First
Whether Qualified in GATE/NET JRF/NET Lecturership/SLET/SET (Yes/No):
Qualified GATE : No
Qualified NET JRF: No
Qualified NET Lecturership: No
Qualified SLET: No
Qualified SET: No
Work Experience Particulars:
S No. Post Held Employer From To Scale of Pay
1. Staff Nurse
Arogayavara
m Medical
Center,
Madana Palle
11/03/2013 6800/-
2. Staff Nurse
Arogayavara
m Medical
Center,
Madana Palle
01/01/2010 10/03/2013 6800/-
Present Position Held: Staff Nurse
Name of the present
Organization:
Arogayavaram Medical Center, Madana Palle
Present Salary: 6800/-(Consolidated pay)
Any other Info:
List of Enclosures
1. SSC
2. Intermediate
3. B.Sc., Nursing Degree
4. B.Sc., Nursing Marksheet-I Year
5. B.Sc., Nursing Marksheet-II Year
6. B.Sc., Nursing Marksheet-III Year
7. B.Sc., Nursing Marksheet-IV Year
8. Certificate of Registration for Nurse
9. Certificate of Registration for Midwife
10. Certificate of Registration for Public Health Nurse
Declaration
I BIJINEMULA AMEEDA hereby declare that all the entries made by me in this application are true to the best of my knowledge
and belief. If any information is found false at any stage, my candidature may be cancelled without assigning any reason thereof.
Date:
Place: Signature of the applicant