Personal Information: Use CAPITAL letters and leave spaces between words.

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1 NTS Eligibility Criteria: REGISTRATION FORM GOVERNMENT OF THE PUNJA PRIMARY & SECONDARY HEALTHCARE DEPARTMENT HEPATITIS CONTROL PROGRAM Screening Test for the post of Screening Test for Staff Posts Charge Nurses A. Is your Age according to the desired Post at the date of ? Reg.. To be Filled by NTS Picture 1 Paste your recent passport size color photograph not older than 6 Months having blue background with gum. Is your Qualification & Experience according to the required post? C. Are you Domiciled in Punjab? If your reply is to A, & C above, only then please proceed further. Otherwise you are not eligible to apply. 01. ank Online Deposit of from Designated ank ranches. ank Code Deposit Date *te: Application Form will not be entertained w ithout Original Deposit Slip (NTS Copy) Personal Information: Use CAPITAL letters and leave spaces between words. 02. Name in Full: 03. s 04. Candidate CNIC #: Write your own CNIC. Or Form. 05. Gender: Male Female 06. Date of irth: Write your Correct Date of irth otherwise you will be rejected D D M M Y Y Postal Address: All correspondence will be made on this address though courier service or ordinary postal service. 08. Phone : (OFF) City Code - Phone City: (RES.) 09. Are you a Government Servant and applying through proper channel? In case of, please attach NOC District: (Mobile) DO NOT give your portable mobile number (which is converted from one network to another) so that SMS delivery is ensured. 10. Are you a Disabled Person? If yes, please attach Disability Certificate 11. Religion: Muslim n Muslim If n Muslim, Please Specify: 12. Are you registered with Pakistan Nursing Council? 13. Desired Test City: Fill Only One ox (Mandatory) (Subject to a minimum of 200 candidates, other wise the candidates will be assigned next nearest test city) 01. Rwp / Isb 02. Multan 03. Lahore Peshawar 06. Karachi 07. Quetta 08. Faisalabad Sahiwal Page 01

2 14. Station Applied For: Fill Only One ox Desired Station. (Mandatory) To apply for more than one station, please use separate form with separate fee. This form will be considered valid only for the first selected station in the sequence. Name of DHQ / THQ 01 DHQ Hospital, Attock 02 THQH, Pindi Gheb, Attock 03 THQH, Fateh Jang 04 THQH, Ahmad Pure East 05 THQH, Hasilpur 06 THQH, Kher Pur Tamewali 07 THQH, Yazman 08 THQH, Samundri, Faisalabad 09 THQH, Jaranwala, Faisalabad 10 General Hospital, Samnabad 11 THQH, Chak Jhumra 12 THQH, Shujaabad, Multan 13 THQH, Khanpur, R.Y.Khan 14 THQH, Liaqatpur, R.Y.Khan 15 THQH, Sadiqabad, R.Y.Khan 16 DHQ ahawalnagar 17 THQH, Minchinabad 18 THQH, Fort Abbas 19 THQH, Chishtian 20 THQH, Haroonabad 21 DHQ Hospital, hakkar 22 THQH, Darya Khan 23 DHQ Hospital, Chakwal 24 DHQ Hospital, Chiniot 25 THQH, Taunsa Sharif 26 THQH Fort Munroo 27 THQH Kharian 28 THQH Sara-e-Alamgir 29 THQH, Wazirabad, Gujranwala 30 THQH, Kamoke, Gujranwala 31 THQH, Naoshehran Virkan 32 THQH, Pindi hattian 33 DHQ Hospital, Hafizabad 34 DHQ Hospital, Jhang 35 THQH, Shorkot, Jhang 36 THQH, Pind Dadan Khan 37 THQH, Sohawa, Jhelum 38 DHQ Hospital, Jhelum 39 THQH, Chunian 40 DHQ Hospital, Kasur 41 THQH, Mian Channu 42 DHQ Hospital, Khanewal 43 DHQ Hospital, Khushab 44 THQH, shera, Khushab 45 DHQ Hospital, Lodhran 46 THQH, Kahroor Pakka, Lodhran 47 THQH, Chaubara, Layyah 48 DHQ Hospital, Layyah 49 DHQ Hospital, M..Din 50 THQH, Phalia, M..Din 51 DHQ Hospital, Mianwali 52 THQH, Piplan, Mianwali 53 THQH, Kot Addu, Muzaffargarh 54 THQH, Jatoi, Muzaffargarh 55 DHQ Hospital, Muzaffargarh 56 DHQ Hospital, Narowal 57 THQH, Shakargarh 58 DHQ Hospital, Nankana Sahib 59 THQH, ShahKot, Nankana Sahib 60 DHQ Hospital, Okara 61 THQH, Depalpur, Okara 62 DHQ Hospital, Pakpattan 63 THQH, Arifwala, Pakpattan 64 THQH, Rojhan, Rajanpur 65 THQH, Jampur, Rajanpur 66 DHQ Hospital, Rajanpur 67 THQH, hagtanwali, Sargodha 68 THQH, Sahiwal, Sargodha 69 THQH, halwal, Sargodha 70 THQH, Chichawatni, Sahiwal 71 DHQ Hospital, Sheikhupura 72 THQ Sharaqpur 73 THQH, Safdarabad, Sheikhupura 74 THQH, Daska, Sialkot 75 THQH,Haveli Lakha 76 DHQ Hospital, T.T.Singh 77 DHQ Hospital, Vehari 78 THQH, urewala, Vehari 79 THQH, Mailisi, Vehari 80 DHQ Government Mian Mir Hospital Page 02

3 15. Academic Information: (Please do not attach copies of your academic certificates at this stage) te: 1. NTS will not issue Roll Slips to those who have not filled in their academic record properly. 2. Candidate should convert their grades into marks. ( O Level / A Level or any other degree having grade). 3. Write exact degree name & major subject mention in certificate / transcript. 4. Result awaiting candidates are not eligible. Certificate / Degree Level Degree Title Specialization / Major Subject Year Passing Obtained Marks / CGPA Total Marks / CGPA oard / University / Institute Matric (10 Years) Intermediate / D.A.E (12 / 13 Years) achelor (14 Years) achelor (Hons) / Master (16 Years) MS / M.Phil (18 Years) Diploma / Certificate 16. Employment Record: (Please do not attach copies of your experience certificates at this stage) Sr # Organization / Employer Name Job Title Job Duration Write only Month & Year From To Total Job Experience as on closing date of application: Days Months Years 18. Total Post Qualification Job Experience as on closing date of application: Days Months Years Undertaking y The Applicant: I d/s/w of do hereby solemnly declare and affirm that I have read and understood the instructions and conditions for appearing in the NTS Test, and I have filled-up the application form as per instructions given below. In case of any information contained herein is found at any stage to be missing, untrue, false or forged, my candidature can be cancelled at any stage (even after employment, if so revealed later), and I shall be liable to legal action. Picture 2 Affix your recent passport size color photograph not older than 6 Months having blue background with Stapler Thumb Impression Candidate s Signature General Instructions / Information: Please fill the Application Form properly with complete and correct information / answers. Please DO NOT leave any field blank, otherwise your application may not be considered. Incorrect, false or forged information may result in cancellation of your candidature at any stage, even after employment, and also proceeding of a legal action. Attach your Two recent Passport Size Photographs, Copy of CNIC and Original ank Deposit Slip (NTS Copy) y Hand submission of Application Form is not allowed. Mobile Phones or any Electronic Gadgets are not allowed in Test Center premises. Use separate envelope and separate application form for each post you are applying for. Page 03

4 Mobile Phones or any Electronic Gadgets are not allowed in Test Center premises. Use separate envelope and separate application form for each post you are applying for. Last date for submission of application form is Wednesday 3 May, Applications received on or after Thursday 4 May, 2017 will be rejected. Application should reach NTS office latest by last date of submission of Application Form. NTS will not be responsible for late receiving of application through courier / Pakistan Post etc. th rd HELP LINE: UAN : Website : Please Send Application Forms to: NATIONAL TESTING SERVICE P&SHD - HCP Charge Nurse (Project) 1-E, Street. 46, Sector I-8/2, Islamabad. Page 04

5 ranch Code: ranch uilding Standards in Educational and Professional Testing Allied ank Limited (Formely: Allied ank of Pakistan Limited) te: ank Service Charges Free of Cost NTS COPY Muslim Commercial ank te: ank Service Charges Free of Cost ranch Code: ranch Allied ank Limited (Formely: Allied ank of Pakistan Limited) te: ank Service Charges Free of Cost uilding Standards in Educational and Professional Testing ANK COPY Muslim Commercial ank te: ank Service Charges Free of Cost ranch: National Testing Service-Pakistan NTS-Pakistan te: ank Service Charges Free of Cost te: ank Service Charges Free of Cost *te: Desired ank Stamp is required on the Deposit Slip & Send Original Deposit Slip (NTS Copy) along Application Form to NTS Office a Application Form will not be entertained without Original Deposit Slip (NTS Copy) ranch:. National Testing Service-Pakistan te: ank Service Charges Free of Cost NTS-Pakistan te: ank Service Charges Free of Cost *te: 1. Please Stamp both copies of deposit Slip. 2. The ank Must Return NTS Copy to the Candidate. 3. Deposit Slip will not accepted without Candidate CNIC/ Form. Project ID: P Project ID: P CNIC / Form : Post CNIC / Form : Post in n Refundable/ n Transferable in n Refundable/ n Transferable ranch Code: uilding Standards in Educational and Professional Testing CANDIDATE COPY ranch Allied ank Limited (Formely: Allied ank of Pakistan Limited) te: ank Service Charges Free of Cost Muslim Commercial ank te: ank Service Charges Free of Cost ranch: National Testing Service-Pakistan te: ank Service Charges Free of Cost NTS-Pakistan te: ank Service Charges Free of Cost *te: Desired ank Stamp is required on the Deposit Slip & Send Original Deposit Slip (NTS Copy) along Application Form to NTS Office. Application Form will not be entertained without Original Deposit Slip (NTS Copy) Project ID: P CNIC / Form : in n Refundable/ n Transferable Post