NATIONAL CENTRE FOR DISEASE INFORMATICS AND RESEARCH
INDIAN COUNCIL OF MEDICAL RESEARCH
Department of Health Research,
(Ministry of Health & Family Welfare),
II Floor of Nirmal Bhawan, ICMR Complex,
Poojanahalli Road, Off NH-7,
Adjacent to Trumpet Flyover of BIAL, Kannamangala Post, Bangalore - 562 110. India.
(APPLICATION FORM FOR ACCOUNT OFFICER (JUNIOR GRADE) POSTS)
Note : All information must be given in words and not by dashes and dots
* fields are mandatory
Name of the post applied for *
Pay Matrix Level
Name of the Institute / Centre 
Payment details
Demand Draft No. * Date (dd/mm/yyyy)
Name of the Bank Amount*
Personal Information
1. Name in Full: (IN CAPITAL LETTERS) *
2. Address:(i)  Present:*
City*
State
Pincode
(ii) Permanent:
City
State
Pincode
(iii) Contact Telephone No. Mobile *
(iv) Email address:*  
3. Date of Birth: *   (dd/mm/yyyy) Gender*
4. Marital Status: Nationality
5. Religion
6. (a) Are you a member of Scheduled Caste / Scheduled Tribe / OBC
(Answer: Yes or No):
If Yes, Select one option
If the answer is Yes,Give Caste
    (b) Are you Physaically Handicapped 
    (If yes then % of Disability)                
Educational Details
7. particulars of all examinations passed and degree and technical qualifications obtained (Commencing with the Matriculation or equivalent examinations). Attach attested copies of all certificates.)
Examination or Degree obtainedClass or DivisionSubject takenDate of PassingGrade / Percentage
Professional Details
8. Professional details
Examination or Degree obtainedClass or Division Subject taken Date of Passing Grade / Percentage
Languages
9. The languages known. State any examination passed in each:
LanguageRead onlySpeak onlyRead and speakExamination passed
 
Work Details
10. Total Experience with details in each area:
11. Major achievements:
12. Awards and prizes received: (Name of Awards, year, awarded by)
Experience Summary
13. Give particulars of Employments held in chronological order:
Select for Current WorkingName of employer & addressDate of joining
(dd/mm/yyyy)
Date of leaving
(dd/mm/yyyy)
Designation & Nature of work performedSalary(excluding allowances) last drawn & scale of payExperience
 YearMonth
 
14. Copies of testimonials
1.
2.
3.
4.
5.
15. Candidate may mention here the details of Annexure, if any. Any other information relevant to the applicant may be mentioned here.
16. Has the candidate applied earlier for any post in the Council or elsewhere? If so,give details.
17. If selected, What notice would you require before joining?
Reference Detail
18. References
(The persons should be resident of India and holders of responsible position. They should be intimately acquainted with the applicant's character and work, but must not be relatives. Where the candidate has been in employment, he would either give his present or most recent employer or immediate superior as a reference or produce testimonials from him in regard to the candidate's fitness for the post for which he is an applicant).
1Name
Occupation or position
Address
2 Name
Occupation or position
Address
3Name
Occupation or position
Address
19. Details of Enclousures
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Declaration
1. I hereby declare that the entries in this form and the additional particulars, if any, furnished herewith are true to the best of my knowledge and belief.
2. I have informed my Head of Office/Department in writing that i am applying for this post and shall produce "No objection" certificate at the time of the interview.
Place
Date (dd/mm/yyyy)