Nurse Application Form

🧾 1. Basic Personal Information

Full Name (as per certificate) *

Gender *

Date of Birth *

Age *

Mobile Number *

Alternate Mobile Number

Email ID *

OTP will be sent to this email for verification

Aadhaar Number (last 4 digits only)

Marital Status

Nationality

Blood Group

🪪 2. Registration Details

WBNC Registered *

Yes

No

WBNC Registration Number

Application Number / Date Scheduled

Date Scheduled (if any)

Parent Council Registration Number

Registration Number

State Nursing Council

Registration Validity From

Registration Validity To

NUID / Application Number

🏠 3. Address Details

Current Address

House / Village / Street

Post Office

Police Station

District

State

PIN Code

Permanent Address

Same as current address

Full Permanent Address

🎓 4. Educational & Nursing Qualification

Highest Nursing Qualification

Name of Nursing College / Institution

University / Board Name

Year of Passing

Total Marks / CGPA

Internship Completed

Yes

No

Internship Hospital Name

🏥 5. Work Experience

Experience Status

Fresher

Experienced

Total Experience (Years / Months)

Current / Last Employer Name

Hospital / Nursing Home Type

Department / Ward

Job Role

Last Drawn Salary

Reason for Leaving

🧠 6. Skills & Specialization

Select all that apply

🕒 7. Job Preference

Profile

Job Type

Preferred Shift

Preferred Location

Expected Salary (Monthly)

Joining Availability

📄 8. Documents Upload

Resume / Bio-Data (PDF/Word) *

Maximum file size: 5MB. Accepted formats: PDF, DOC, DOCX

💉 9. Health & Declaration

Any Major Health Issue?

Yes

No

COVID Vaccinated

Yes

No

Willing to work night shifts?

Yes

No

Declaration: I confirm that all information provided is true and correct. I agree to share my profile with verified employers for recruitment purposes. I understand that any false information may lead to rejection of my application.

📝 Nurse Application Form