Form and info for application to govt of gujarat as dentist on adhock bases.

1. HFC[ZFT S|DFSov BDS/2012-13/1
NT;H"GGL V[0CMS EZTL
VFZMuI VG[ 5lZJFZ S<IF6 lJEFU4 ;lRJF,I4 UFWLGUZ C:TS
;FD]lCS VFZMuI S[gN=M q CMl:58,M BFT[ NT;H"G JU"vZ s5UFZ WMZ6
~FP)4#__v #$4(__qv U|[0 5[ ~FP54$__qvfGL )# HuIFVM TN|G
V[0CMS WMZ6[ SZFZYL JW]DF JW] !! DF; DF8[ H EZJF 5;NUL sD[ZL8f
IFNL T{IFZ SZJF NT;H"GM 5F;[YL lGIT GD]GFDF 5]ZF GFD q ;ZGFDF
;FY[GL ;L,AW SJZDF VZHLVM DUFJJFDF VFJ[ K[P
X{1Fl6S ,FISFTov ALP0LPV[;P (BDS)
JI DIF"NF ov #_ JQF"YL JW] GCLP sTFP#_q)q!Z GL l:YlTV[f
,FISFT WZFJTF pD[NJFZMV[ lGIT SZ[, GD]GFDF ;5]6" lJUTM
EZLG[ ;ZSFZL SFDSFHGF ;DI NZdIFG TFPZ5q)q!Z YL TFP!Zq!_q!Z
;]WLDF SlDxGZzL4 VFZMuI4TALAL ;[JFVM VG[ TALAL lX1F6 sVFZMuI
lJEFUf a,MS GP54 5|YD DF/4 0MPHLJZFH DC[TF EJG4 UFWLGUZ GF
GFDHMU ZHLP5MPV[P0LPq:5L0 5M:8 wJFZF H VZHL DMS,L VF5JFGL
ZC[X[P ;L,AW SJZ p5Z ccNT ;H"GGL HuIF DF8[ VZHLcc V[D :5Q8
NXF"JJFG] ZC[X[P
lGIT SZ[, GD]GF l;JFIGL4 VG[ ;DIDIF"NF ACFZ D/[, TYF
VW]ZL lJUTJF/L VZHLVM T[DH ;FNL 85F, q S]lZIZ wJFZF S[ ~A~DF
D/[, VZHLVM VF5MVF5 ZN YI[, U6FX[P
VFZMuI lJEFUGL J[A;F.8 (Website)www.gujhealth.gov.in)
p5ZYL lGIT GD]GFGL VZHLGM GD]GM D[/JLG[ T[ H GD]GFDF VZHL
SZJLP lGIT GD]GFGL VZHLDF ;5]6" DFlCTL EZLG[ pD[NJFZGL ;CL
;FY[GL VZHL H DMS,L VF5JFGL ZC[X[P
VZHL SZJF AFATDF H~ZL ;]RGFVM TYF V[0CMS EZTLGL
5|lS|IFGL lJUTM T[DH NT;H"GGL HFlTsS[8[UZLfJF.h HuIFVMGL lJUT
NXF"JT] 5+S 56 J[A;F.8 p5Z NXF"J[, K[P
;CLqv
s5LPS[PTG[HFf
SlDxGZ4
VFZMuI4TALAL ;[JFVM VG[ TALAL
lX1F64 sVFZMuI lJEFUfUFWLGUZ

2. HFC[ZFT S|DFS ov BDS/2012-13/1 VgJI[ NT;H"GGL HuIF DF8[GL VZHL
******************************************************************************
5|lT4
VU| ;lRJzL4 VFZMuI VG[ 5lZJFZ S<IF6 lJEFU4 ;lRJF,I4 UFWLGUZ pD[NJFZGM ;CL
s!f pD[NJFZG] GFD ov ;FY[GM TFH[TZGM
sV8SqGFDql5TFv5lTG] GFDf 5F;5M8" ;F.hGM
sZf ;ZGFD] ov OM8M VCL
,UFJJMPs!_f
s#f ;5S" GAZ sDMAF., GAZf ov (I) PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP (II) PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
s$f HgD TFZLB :S], ,LJLU ;8L"OLS[8 D]HA ov TFPov q q!)
s5f 0[g8, SM,[H q SM,[HG] GFDqXC[Z I]lGJ;L"8LG] GFDqZFHI
I]lGJ;L"8LGL lJUT ov
s&f OF.G, BDS 5F; SIF" VU[GL lJUT ov
OF.G, BDS OF.G, BDS OF.G, BDS DF OF.G, BDS OF.G, BDS 5F;
5F; SIF"G] JQF" GF S], U]6 D[/J[, U]6 5F; GF 8SF % SIF"GF 5|ItG
(Attempt)
s*f U]HZFT :8[8 0[g8, SFpg;L, ov ZHL:8=[XG GAZ TFZLB
VDNFJFN G] ZHL:8=[XG sOZHLIFTf A-
s(f HFlT VU[GL lJUT ov HGZ,(GEN) V[;;L(SC)
V[;8L(ST) V[;.AL;L (SEBC)
HFlT 5|DF65+GL lJUT ov ;8L"OLS[8 GAZ TFZLB
V[;.AL;L GMG lS|DL,LIZ ;"8LOLS[8 GL lJUTov 5lZlXQ8vS GM GAZ TFZLB
s)f OLhLS, C[g0LS[5GL lJUT ov PH
;LJL, ;H"GzL wJFZF VF5[, OLhLS, 8SFJFZL % ;8L"OLS[8 GAZ TFZLB
C[g0LS[5GL 5|DF65+GL lJUTov
AFC[WZL ov VFYL C] HFC[Z SZ] K] S[4 p5ZGL H6FJ[, DFlCTL ;5}6"56[ ;tI K[P VF DFlCTL BM8L S[ U[ZDFU[" NMZGFZL H6FX[
TM T[ DF8[ ;ZSFZzL H[ 5U,F ,[X[ T[ DG[ AWGSTF" ZC[X[P V[0CMSqSZFZ VFWLG SFDULZL VU[ H[ XZTM 9ZFJJFDF
VFJX[ T[ DG[ AWGSTF" ZC[X[P
TFZLBov PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
:Y/ ov spD[NJFZGL ;CLf

3. HFC[ZFT S|DFS ov BDS/2012-13/1 VgJI[ NT;H"GGL HuIF DF8[GL lGIT GD]GFGL VZHLDF
X{1Fl6S ,FISFTGF 5|DF65+M 5ZYL DFlCTL EZJF H~ZL ;]RGFVMP
******************************************************************************
s!f pD[NJFZV[ ;F{ 5|YD V8Sq 5MTFG] VFB] GFDql5TFv5lTG] VFB] GFD ,BJFG] ZC[X[P
V8SqGFDDF O[ZOFZ CMI TM U[h[8GF ;8L"OLS[8 D]HA T[DH D[Z[H ;8L"OLS[8 D]HA lJUT EZJLP
sZf ZC[9F6G] 5]Z[5]Z] ;ZGFD] 5LGSM0 GAZ ;FY[ ,BJFG] ZC[X[P
s#f DMAF., GAZ GL lJUT ,BJLP
s$f :S], ,LJLU ;8L"OLS[8DF NXF"J[,L H HgD TFZLB ,BJFGL ZC[X[P
s5f 0[g8, SM,[HG] GFDqXC[Z TYF I]lGJ";L8LG] GFDqZFHIGL lJUT ,BJLP
s&f OF.G, BDS 5F; SIF"G] JQF"4 S], U]6qD[/J[, U]6q8SF VU[GL lJUT OF.G, BDS 5F; SIF"GL DFS"XL8
p5ZYL EZJFGL ZC[X[P T[DH 5|ItG (Attempt) VU[GL lJUT SM,[HGF ;8L"OLS[8 p5ZYL EZJFGL ZC[X[P
s5|ItGGF SM,DDF 5|YDqALHMq+LHMPPPT[ 5|DF6[ lJUT NXF"JJLf
s*f pD[NJFZV[ VZHLGL TFZLBGF ;DIUF/F NZdIFG U]HZFT :8[8 0[g8, SFpg;L,vVDNFJFNG] ZHL:8=[XG
;8L"OLS[8 OZHLIFT D[/J[, CMJ] H~ZL K[P T[ ;8L"OLS[8 5ZYL H ;8L"OLS[8 GAZ4 TFZLBGL lJUT OZHLIFT
,BJLP pD[NJFZV[ U]HZFT :8[8 0[g8, SFpg;L,vVDNFJFN DF DF+ VZHL SZLG[ OL EIF" VU[GL 5CMR
D[/JLG[ T[GL lJUTM ZH] SZ[, CX[ TM T[ DFgI U6FX[ GCLP
s(f HFlT DF8[ HGZ,(GEN)qV[;;L(SC)qV[;8L(ST)qV[;.AL;L (SEBC) p5Z Z 8LS DFS" SZJ]P
OST D]/ U]HZFTGF H V[;;L(SC)qV[;8L(ST)qV[;.AL;L (SEBC) pD[NJFZV[ HFlT 5|DF65+
;8L"PGAZ VG[ TFZLB GL lJUTM ,BJFGL ZC[X[P
V[;.AL;L (SEBC) pD[NJFZV[ T[VMGM pgGT JU"DF ;DFJ[X YTM GYL T[ DT,AG] ;FDFHLS gIFI VG[
VlWSFZLTF lJEFUGF TFP&qZq)&GF 9ZFJYL lGIT YI[, 5lZlXQ8vS DF TFP#!q#q!ZGF ZMH 5]ZM YI[,
Z_!!v!ZGF GF6FSLI JQF"GL VFJSG[ wIFG[ ,.G[ TFP!q$q!Z GF ZMHYL HFC[ZFTGL K[<,L TFZLB ;]WL
IMuI ;tTFlWSFZLV[ VF5[, CMJ] HM.V[ VG[ VF 5lZlXQ8vS GM GAZ VG[ TFZLB lGIT GD]GFGL
VZHLDF NXF"JJFGM ZC[X[P %FlZlXQ8vS GF :YFG[ V[G[1FZvV[ sVU|[HLDFfG] 5|DF65+ DFgI U6FX[ GCLP
s)f OLhLS, C[g0LS[5 pD[NJFZ CMI TM (PH) p5Z  8LS DFS" SZJ]P
OLhLS, C[g0LS[5 (PH) pD[NJFZV[ ;LJL, ;H"GzLGF 5|DF65+GF VFWFZ[ ;8L"PGAZ VG[ TFZLB GL
lJUTM VR]S ,BJLP
s!_f OM8MU|FO VR]S ,UFJJMP
BF; GMW ov lGIT GD]GFGL VZHL V[v$ ;F.hGF SFU/ p5Z H SZJFGL ZC[X[P T[DH VZHLDF pST
TDFD lJUTM U]HZFTL EFQFFDF H EZJFGL ZC[X[P lGIT GD]GFGL VZHLGL ;FY[ SM.56
5|DF65+MGL GS, HM0JL GCLP

4. HFC[ZFT S|DFS ov BDS/2012-13/1 VgJI[ NT;H"GGL V[0CMS EZTLGL 5|lS|IF VU[GL lJUT
s!f NT;H"GGL EZTL TN|G V[0CMS WMZ6[ SZFZYL JW]DF JW] !! DF; DF8[ H K[P T[ 5C[,F lGIlDT EZTLYL
U]HZFT HFC[Z ;[JF VFIMU (GPSC) wJFZF pD[NJFZM 5|F%T YX[ TM T[JF ;HMUMDF !! DF; 5C[,F 56
K]8F SZJFDF VFJX[P T[ DF8[ VgI SM. ZH]VFT wIFG[ ,[JFDF VFJX[ GCLP
sZf NT;H"GGL EZTL D[ZL8 VFWFZLT SZJFDF VFJX[P
s#f NT;H"GGL 5;NUL sD[ZL8f IFNL HFlTsS[8[UZLf JF.h T{IFZ SZJFDF VFJX[P
s$f pD[NJFZ[ lGIT GD]GFGL VZHL EZTL JBT[ H[ HFlT sS[8[UZLf DF lJUT NXF"J[, CX[ T[ H HFlT sS[8[UZLf
DF T[VMGM ;DFJ[X SZJFDF VFJX[P VGFDT HFlT sS[8[UZLf DF OST D]/ U]HZFTGF VG];]lRT HFlT4
VG];]lRT HGHFlT VG[ ;FDFHLS VG[ X{1Fl6S 5KFT JU"GF pD[NJFZMGM H ;DFJ[X SZJFDF VFJX[P
s5f V+[ D/[, lGIT GD]GFVMGL VZHLVM p5ZYL NT;H"GV[ OF.G, BDS 5ZL1FFDF D[/J[, U]6sDFS";f
TYF D[/J[, 8SFJFZL T[DH OF.G, BDS 5ZL1FF S[8,F 5|ItG[ (Attempt) 5F; SZ[, K[ T[GL lJUTM
wIFG[ ,.G[ NT;H"GGL 5;NUL sD[ZL8f IFNL T{IFZ SZJFDF VFJX[P
s&f OF.G, BDS 5ZL1FFDF YI[, 5|ItG (Attempt) DF V[S SZTF JW] 5|ItG CX[ TM NZ[S JWFZFGF 5|ItG
NL9 D[/J[, U]6DFYL #_ U]6 AFN SIF" AFN D[/J[, U]6GL U6TZL SZLG[ 8SFJFZL GSSL SZJFDF VFJX[P
s*f VF V[0CMS EZTL DF+ OF.G, BDS DF D[/J[, D[ZL8 VFWFlZT CMI T[DF SM. ,[lBT S;M8L S[ DF{lBS
S;M8L ,[JFDF VFJX[ GCLP OF.G, BDS GL 8SFJFZLvD[ZL8 VFWFZLT 5;NUL SZJFDF VFJX[P
s(f pD[NJFZ 5MT[ VFBZL 5;NUL IFNLDF ;DFlJQ8 YJF DF+YL ;AlWT HuIF p5Z lGD6]S SZJFGM CSSNFZ
YX[ GCLP H[ T[ TASS[ VF pD[NJFZG[ lGD6]S G VF5JFGM lG6"I ,. XSX[ VG[ VF AFAT[ lGD6]S
;tTFlWSFZLGM lG6"I VFBZL U6FX[P
s)f VF EZTL SM.56 SFZ6M;Z ZN SZJFGL S[ T[DF SM. O[ZOFZ SZJFGL S[ HuIFVMGL ;bIFDF JWv38
SZJFGL VFJxISTF pEL YX[ TM T[D SZJFGM ;ZSFZzLG[ ;5]6" CSS q VlWSFZ ZC[X[ VG[ VF DF8[ SFZ6M
VF5JF AWFI[, ZC[X[ GCLP
s!_f VF ;JU"GL EZTL 5|lS|IFDF VFBZL 5;NUL 5FD[, pD[NJFZ lGD6]S ;tTFlWSFZL 9ZFJ[ T[ XZTMG[ VFlWG
lGD6]S D[/JJFG[ 5F+ 9ZX[P

5. NT;H"G JU"vZ GL HuIFGL HFlTsS[8[UZLf JF.h DFlCTL NXF"JT] 5+S
VPGP ;JU" HFlTsS[8[UZLf JF.h NT;H"GMGL ;bIF NT;H"GMGL
(GEN/SEBC/SC/ST) BF,L HuIFGL
;bIF
GEN SEBC SC ST
1 2 3 4
1 NT;H"G JU"vZ 42 30 1 20 93
TFPSP ;ZSFZzLGF 5|J"TDFG lGIDFG];FZ DlC,FVM DF8[ T[DH OLhLS,L C[g0LS[5 pD[NJFZM
DF8[ HuIFVM VGFDT ZC[X[P