Full Name

Present Address *

Area

Dist. *

State *

Postal Code *

Country *

Permanent Address *

Area

Dist. *

State *

Postal Code *

Country *

Phone / Mobile no. *

Alternate Phone / Mobile no.

Email Address *

Date of Birth *

Candidates age should not be less than 17 years as on December 31st 2022

Height *

Weight *

Nationality *

Domicile State *

Father's / Guardian's Name *

Occupation *

Designation *

Annual income *

Mother's Name *

Occupation *

Designation *

Annual Income

INR

Number of children *

Age of 1st child *

Age of 2nd child *

Age of 3rd child *

Age of 4th child *

Age of 5th child *

Select your qualification *

Name of School / Institution *Enter name of School / Institute in 10th

Name of Board / University *Enter name of Board / University in 10th

Subjects Taken in 10th *

Total Marks (Percentage) *

Passing Year *

Name of School / Institution *Name of School / Institution in 12th

Name of Board / University *Name of Board / University in 12th

Subjects Taken in 12th *

Total Marks (Percentage) *

Passing Year *

Extracurricular activities

Have you done any other nurses training before? *YesNo

Course Title *

Course Duration *

Name of the Institute *

Add more nurses training details *YesNo

Course Title *

Course Duration *

Name of the Institute *

Add more nurses training details *YesNo

Course Title *

Course Duration *

Name of the Institute *

Name of the person who meet the financial requirements for your training *

Are you a sponsored candidate ? *YesNoFor sponsored candidates, uploading a copy of sponsorship letter is mendatory

Mother Tongue *

Write your mother Tongue *

Other Languages Known (Read)

Other Languages Known (Write)

Other Languages Known (Speak)

Select your religion *

Enter your religion *

Write your denomination *

Pastor's / Elder's name *

Address of pastor / elder *

Do you had any major illness in the past ? *YesNo

Details of illness *

After completion of your training, you will be posted in any one of the EHA hospitals to complete your service commitment. Do you agree? *YesNo

Why do you want to become a Nurse? (Write briefly) *Maximum 1000 characters allowed0 / 1000

Reasons for applying to this Nursing School: *Maximum 1000 characters allowed0 / 1000

Upload your photograph *

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Recent color photo of candidate. Supported format - jpg, jpeg, png, tiff. Maximum file size - 200 kb.

Upload your signature *

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Candidates signature. Supported format - jpg, jpeg, png, tiff. Maximum file size - 200 kb.

Upload your 10th Marksheet *

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Upload 10th marksheet. Supported format - .pdg only. Maximum file size - 200 kb.

Upload your 12th Marksheet (if any)

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Upload 12th/Intermediate marksheet (if any). Supported format - .pdg only. Maximum file size - 200 kb.

Upload your sponsorship letter *

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Upload your sponsorship letter. Supported format - pdf only. Maximum file size - 200 kb.

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Transaction ID *Please enter correct transaction id to avoid candidatureship cancellation