No. LGB/EsIt/PWD/1 8 041 a,}ofuq dlfurcr qr6a effiq araftr wrs q se rrar aagt' Bnl{ar fuq 66sool LGB REGIONAL INSTITUTE OF MENTAL HEALTH (Govt. of India, Ministry of Health & Family Welfare) Post Box No. 15: FAX No. (037 t2) 233623 TEZPUR:: 784001 :: ASSAM 5 I 08 Dated l" Jan'2016 ADVERTISEMENT (2nd Attempt) Applications on prescribed format are invited from the citizens of India for filling up the following posts under special recruitment drive for Persons with Disabilities (pwd) catelory as ied below so as to reach bv 21.0 2016. Sl. No Identified Posts No. of Pay Band & Grade Pay Age Post Limit I Assistant Professor. I Rs.15,600-39,100 + AGP 7.000+ 50 years Psychiatry NPA 2. Staff Nurse 2 Rs.9,3 00-34,800+GP 4600 35 years (i) Essential Qualification for Assistant Professor Psychiatry: A recognized medical qualification included in the First or Second Schedule or Part-II of the Third Schedule (other than licentiate qualifications) to the Indian Medical Council Act, 1956. Holders of educational qualifications included in Part-II of the Third Schedule should also fulfill the condition stipulated in sub-section (3) of section (13) of the Indian Medical Council Act, 1956. (id Post-graduate degree in the concemed specialty mentioned in Schedule-Vl or equivalent. Recognized DNB qualification awarded by National Board of Examination. Essential Experience for Assistant Professor Psychiatry: (i) At least 03 years teaching experience in the concerned specialty as Lecturer /Tuior /Registrar/ Demonstrator/Sr. Resident in a recognized institution/college after the requisile post-graduate degree qualification. Note: Teaching experience in any other post like the post of general Duty Medical Officer/\zledical Officer shall not be considired for eligibility purp'ose for recruitment to teaching posts. (ii) Essential Qualification for Staff Nurse: (i) HSSLC passed (ii) Registered Nurse (GNM/B.So. Nurse) (iii) Registration with INC or State Nursing Council is a must. Note: 1' The above posts are reserved for PWD (Persons with Disabilitiesf category candidates who suffer not less than 4Oo/o of relevant disability with under mentioned physical requirements / suitabitity: Post Physical Requirements Categories of Disabled suitable for jobs Assistant S, SE, ST, MF, KC, C, OL (OneLeg) Professor Staff Nurse S, ST, W, MF, SE, OL (OneLeg) RW, H, C. ABBRwIATIoNS: s=sitting, se=seeing, sr=standing, MF=Manipulation by Fingers, KC=Kneeling and crouching, c=communication, r{=hearing, W=Walking, RW=Reading and Writing. Note: 2 - A person who wants to avail benefit of reservation would have to submit a Disability certificate issued by a competent authority in format given in Annexure - I
GENERAL CONDITIONS (1) Candidates who do not fulfill ent of advertisement need not apply. (2) All Qualification should Medical be recognized (4) Candidates working in proper channel or submit o,no Siate/Cr lhe^mci:(3) Age will be calculatedas on 01.01.2016. Govt./PSUiAutonomous Body must apply through certificate" (5) Relaxation applicable in upp.. in age case limit of will SC/ST be for, years and OBC candidates 3 as per norms. (6) the Central In re of deputation, vigilance from clearance/integrity the parent department certificate will be required. (7) Appointments recruitment in will case be of on direct to, (two) applications received after the last..? _ years (8) Incomplete application or will be summarily rejected. prescribed format is to 1ej fne application be in accom ed with attested copies of photograph all certificates/one pp so as to reach size to the ninistrative Officer, LGBRIMH, by 21.01.2016 Tezpur-7g4001 during latest working hours. (10) outstation candidates paid cailed 2"d forlnterview class Railway Faredus will be Fareon production of Railway/Bus route as per Tickets Institute's by the rules. shortest No traveling allowance will be admissible The reimbursement to u r.*irrg is candidate. subjecto the cordition that the journey place is actually to which commenced call letter has from been the senlfor attending interview. (1r) likely Interviedselection to be held on 30.01 test.2016. (12) is Iected candidates will require to join notice. (13) duty within Canvassing short any form ill be treated as disqualification. (la) submit application Candidates through may e-mail at ntlsbri Director LGBzuMH
LGB REGIONAL INSTITUTE OF MENTAL IIEALTH (APPLICATION FORM FOR F'ACULTY POST/OTHER POST) Post Applied For: 1. Full Name (in Block letter) 2. Father' s/f{usband Name Please affix a recent Passport size photograph with your signatures 3. (a) Date of Birth (b) Age as on 01.01.2016 4. a. Whether belong to pwd: yes /No b. PWD category: OL/OA (enclosed copy of the certificate) 5. Caste (Please{ Mark): SC ST OBC UR 6. Relision: 7. AdvertisementNo.LGB/Estt/pwD/1804/15/0g Dated 01.01.2016 8. Application Fee: 9. Sex: NIL Male Female 10. Address for Communication: 11. Mobile No. 12. Email. I.D 13. Permanent Address: 14. Academic and Professional eualifications Percentage of Marks/Grade/ Name of Board/ Univ./Institution Month & Year of 15. MCV INC Registration No. gt
16. Publications: (Please attach list of papers published in indexed and non- indexed journals) 17.Pfizes, Honours, Awards Distinctions. if anv: 18. chronological record of employment (Use additional sheets, if necessary) Name & address of Organization Post held Duration Scale ofpay/ Pay From To band + GP Nature of duties Performed 19. Nature of present employment (please{ Mark): Temporary I Permanent 20.In case the present employment is held on Deputation/ contract basis, please state: a) The date of initial appointment : b) Period of appointment on deputation/contract c) Name of the parent office/ organization to which you belong : 21. Additional details tar about nt employment. Please Marl State Central Autonomous Organization (Central or State Govt.) Undertaking (Central or State Govt.) Universities Others 22. Ate you in the Revised Scale of pay? If yes, give the date from which the revision took place and also \ indicate the pre- revised scale. (a) Total emoluments per month, now drawn: 23. Additional information, if any, which you would like to mention in support of your suitability for the post. (This among other things may provide information with regard to (i) additional Academic qualifications (ii) professional training and (iii) work experience over and above prescribed in the vacancy circular / advertisement) (Nlote: Enclose a separate sheet, if the space is insufficient).
24. Please give the names, designation & address @-mail, Fax & Phone numbers) of two referees under whom you have worked. i) ii) DECLARATION I have carefully gone through the vacancy circular/advertisement and I am well aware that the bio-data, duly supported by documentsubmitted by me will also be assessed by the selection committee at the time of selection for the post. I hereby declare that the information given by me in this application is true and correcto the best of my knowledge and belief. I understand that in the event of any of the information being found false or incorrecg my candidature for the examination / interview is liable to be rejected. In the event of any mis-staiement/ discrepancy in the particulars being detected at any stage even after my selection, my appointment is liable to be terminated without anv notice. Place: Date: Signature of candidate
Certificate to he gree! hv=fhe Head of the Office / Tleott. of the Anplicant (To be filled up only in case of rransfer on Dep,rtation; l. 2. J. 4. 5. official axe correct as per service record. ) case is pending or contemplated againsthe rgle. He will be relieved of his duties to take up assignment in the LGBRIMH on his/her selection. Last 5 years ACRs dossier's /attested copies of last 5 years ACRS are forwarded herewith sealed in cover. Signature A.lame ldesignation with office seal
NAME & ADDRESS OF THE INSTITUTE / HOSPITAL : ANNEXURE. I Certificate No. Date: DISABILITY CERTI!FCATE Recent photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board This is certified that Shri/SmVKum... suttering from permanent disability of following category : 1. A. Locomotor or cerebral palsy : (i) BL-Both legs affected but not arms (ii) BA-Both arms affected 1a) tmpaired reach (b) Weakness of grip (!ii) BLA-Both tegs and both arms affected (iv) ol - one teg affected (right or reft) (a) rmpaired reach (b) Weakness of grip (c) Ataxic (v) OA - One arm affected (a) lmpaired reach (b) Weakness of grip (c) Ataxic (v!) BH - stiff back and hips (can not sit or stoop) (vii) MW-Muscularweaknessandlimitedphysiciiendurance. B. Blindness or Low Vision (i) B-Btind (ii) PB - Partiaily Btind C. Hearing impairment: (i) D-Deaf (ii) PD-Partiatty Deaf (Delete the category whichever is not applicabte)... Son/wife/daughter of Shri 2, This condition is. progressive/non progressive/likely to improve/not likely this case is not recommbnded / ' ' to improve. Re-assessment of is recommenddd after a period of,..years..,..,.,..months*. 3. Percentage of disability his/her case is... percent. 4' ShriiSmt'/Kum.'...'....meets the following physical requirements for discharge of his/her duties. (i) (ii) (iii) (iv) (v) (vi) (vii) (viii) (ix) (x) (xi) F-can performa work by manipulating with fingers PP-can perform work by pulling and pushing L-can perform work by lifting KC-can perform work by kneeling and crouching B-can perform work by bending S-can perform work by sitting ST-can perform work by standing W-can perform work by walking SE-can perform work by seeing H-can perform work by hearing/speaking RW-can perform work by reading and writing YesiNo (Dr ) (Dr (Dr... Member ) Chairperson MedicalBoard Medical Board *strike out whichever is not applicable. Countersigne d by the MedicalSuperintendenVCMO/Head of Hospital(with seal)