M.sc. Nursing Form

8/6/2019 M.sc. Nursing Form

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RAJASTHAN UNIVERSITY OF HEALTH SCIENCES,JAIPUR

Application Form for M.Sc. Nursing Entrance Examination 2011 - 12For Admission to M.Sc. Nursing (2 Year) Course

(To be kept in the Record of the University)

RUHS Registration No.................................................................................................(For Official use )

SUMMARY SHEET

Enter the Category for which application form is being submitted:Category Code

In-Service- General 1 Non-Service General 6In-Service- SC 2 Non-Service SC 7In-Service- ST 3 Non-Service ST 8In-Service- OBC 4 Non-Service OBC 9In-Service- SBC 5 Non-Service SBC 10

1. Full Name (in Capital Letters)

__________________________________________________________

2. (a) Fathers Name

__________________________________________________________

(b) Mothers Name

__________________________________________________________

3. Date of Birth Date Month

Year

4. Sex Male / Female

5. Telephone Nos. (with STD Code) (R) .........................................(O) ...............................................

(M).........................................(Fax) ............................................

6. Are you entitled for benefit under Disabled Category Yes/No .....................................

7. Are you entitled under In-Service Category. Yes/No, If yes(Teaching/Clinical) ...............

8. Date of completion of B.Sc. Nursing / B.Sc. Nursing (Trained & Registered) / Post

Basic B.Sc. Nursing (Hons) (.....................................................) with Aggregate Marks

........................


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Work Experience from ....................................... to ...................... TotalService ...........................

9. Permanent Registration Number with the State Nursing Council.

R.N. R.M. State

Note: - Incomplete application forms due to any shortcoming(s)will be rejected. No further communication will be made to

the candidates in this regard.

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RUHS Registration No. ..............(For Official use) RollNo..........................

(Leave Blank)

Price: 1200/- DD No................................ Dated ............................. DraweeBank .....................................

RAJASTHAN UNIVERSITY OF HEALTH SCIENCES, JAIPURApplication Form for M.Sc. Nursing Entrance Examination 2011 - 12

For Admission to M.Sc. Nursing (2 Years) Course(To be kept in the record of the University)

Enter the Category for which application form is being submitted:

Category CodeIn-Service- General 1 Non-Service General 6In-Service- SC 2 Non-Service SC 7In-Service- ST 3 Non-Service ST 8In-Service- OBC 4 Non-Service OBC 9In-Service- SBC 5 Non-Service SBC 10


......................................................................................................

2. (a) Fathers Name

......................................................................................................

(b) Mothers Name

......................................................................................................


Year


5. Full Postal Address......................................................................................................

AFFIX YOURRECENT

PHOTOGRAPHduly signed by the

candidate andattested

by Principal of his/herNursing college/orDMHS/Gazetted

Officer


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................................................................................

......................

City ..........................................................Pin ............................

Telephone Nos. (with STD Code) (R) .........................................(O) ...............................................

(M).........................................(Fax) ............................................

6. Are you entitled for benefit under Disabled Category Yes

/No ...................................................

(If yes, please attach a valid certificate)

7. Are you entitled under In-Service Category. Yes/No .................... If yes

(Teaching/Clinical)

(if yes, attach the requisite certificate issued by DMHS, Jaipur)

8. State/Union Territory to which you

belong ............................................................................................

9. Nationality .......................................................................

10. Which Category you belong to

SC/ST/OBC/SBC/General .................................................................

(SC/ST/OBC/SBC candidates must attach an attested copy of the caste certificate)

OBC/SBC certificate should be issued on or after dated 01-04-2011

11. Eligibility criteria of Non-Service Candidate .............................................................see Instruction Booklet for details and attach attested copy of requisite certificatesmust specify following details of Final B.Sc. Nursing Examination of University ofRajasthan / Rajasthan University of Health Sciences, Jaipur / other University.Name ofExamination ...................................................................................................................................Name ofCollege ............................................................................................................................................Whether College is recognized by INC .................................................Attach the certificates from the Principal of the Concerned Nursing College.Attach the certificates of work experience from the Concerned Employer.

12.Permanent Registration Number with the State Nursing Council.

R.N. R.M. State

13. Professional Qualification: Details of Marks obtained in B.Sc. Nursing, B.Sc. Nursing(Trained & Registered) / Post Basic B.Sc. Nursing (Hons) Examination.

14.Attach DD of Rs. 1200/- in the name of "The Registrar, Rajasthan University ofHealth Sciences payable at Jaipur.DD No. ...................................... Dated........................................ DraweeBank................................

Details of Educational QualificationsB.Sc.

NursingName of the

University/InstitutionState in which

College /Institutionsituated

Month & yearof Passing

Percentageof MarksObtained

Total No. of timesappeared in the

examinationincluding the one in


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which passedPart-lPart-llPart-lllPart-lV

Attach attested copies of the Degree / Provisional Certificate and Mark-sheets related to theB.Sc. Nursing, B.Sc. Nursing (Trained & Registered) / Post Basic B.Sc. Nursing (Hons)Examination. mentioned above.

DECLARATIONI hereby solemnly and sincerely affirm that the statements made and

information furnished by me in the application form and also in the enclosuressubmitted by me are true and correct. I have not kept any information secret.Should it, however, be found that any information furnished herein isfraudulent/incorrect or untrue in material particulars, I realize that I am liable tocriminal prosecution. I agree to abide by the Rules and Regulations governingthis examination and as contained in the instruction booklet. I understand thatmy admission will be provisional and if at any later stage, I am found ineligible,it will automatically stand cancelled.

Left Hand Thumb Impression Right Hand Thumb Impression

Signature of theCandidate

Verified by :

(Signature & Seal)

Date: ............................2011Place: ................................... Signature & Thumb Impression should be verified and marked in presence ofPrincipal of School/ College last attended/ Gazetted Officer/Executive Magistrate.Note: Candidate must sign the form and affix Left & Right Thumb Impression failing which the

application form will be rejected.

RUHS Registration No. ...............................(For Official use) RollNo..........................

(Leave Blank)

Price: 1200/- DD No................................ Dated ............................. DraweeBank......................................

RAJASTHAN UNIVERSITY OF HEALTH SCIENCES, JAIPURApplication Form for Pre-M.Sc. Nursing Entrance Examination 2010 - 11

For admission to M.Sc. Nursing (2 Year) Course(To be kept in the record of the Nursing College)

Enter the Category for which application form is being submitted:

In-Service- General 1 Non-Service General 6In-Service- SC 2 Non-Service SC 7

Category Code

In-Service- ST 3 Non-Service ST 8In-Service- OBC 4 Non-Service OBC 9In-Service- SBC 5 Non-Service SBC 10

AFFIX YOUR

RECENTPHOTOGRAPHduly signed by the


by Principal ofhis/her Nursing

college/orDMHS/Gazetted

Officer


......................................................................................................


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2. (a) Fathers Name

......................................................................................................

(b) Mothers Name

......................................................................................................


Year


5. Full Postal Address......................................................................................................

................................................................................

......................

City ..........................................................Pin ............................

Telephone Nos. (with STD Code) (R) .........................................(O) ...............................................

(M).........................................(Fax) ............................................

6. Are you entitled for benefit under Disabled Category Yes/No ...................................................(If yes, please attach a valid certificate)

7. Are you entitled under In-Service Category. Yes/No .................... If yes(Teaching/Clinical)(if yes, attach the requisite certificate issued by DMHS, Jaipur)

8. State/Union Territory to which youbelong ............................................................................................

9. Nationality .......................................................................10. Which Category you belong to

SC/ST/OBC/SBC/General .................................................................(SC/ST/OBC/SBC candidates must attach an attested copy of the caste certified)OBC/SBC certificate should be issued on or after dated 01-04-2011

11. Eligibility criteria of Non-Service Candidate See Instruction Booklet for details andattach attested copy of requisite certificates, must specify following details of FinalB.Sc. Nursing Examination of University of Rajasthan / Rajasthan University of HealthSciences, Jaipur / other University.Name ofExamination ...................................................................................................................................Name ofCollege ............................................................................................................................................Whether College is recognized by INC .................................................Attach the certificates from the Principal of the Concerned Nursing College.Attach the certificates of work experience from the Concerned Employer.

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12.Permanent Registration Number with the State Nursing Council.

R.N. R.M. State


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13. Professional Qualification: Details of Marks obtained in B.Sc. Nursing, B.Sc. Nursing(Trained & Registered) / Post Basic B.Sc. Nursing (Hons) Examination.

14.Attach DD of Rs. 1200/- in the name of "The Registrar, Rajasthan University ofHealth Sciences payable at Jaipur.DD No. ...................................... Dated........................................ DraweeBank................................

Details of Educational QualificationsB.Sc.

NursingName of theUniversity /Institution

State in whichCollege /

InstitutionSituated

Month & yearof Passing

Percentageof MarksObtained

Total No. of timesappeared in the

examinationincluding the one in

which passedPart-lPart-llPart-lllPart-lV

Attach attested copies of the Degree / Provisional Certificate and Mark-sheets related to theB.Sc. Nursing, B.Sc. Nursing (Trained & Registered) / Post Basic B.Sc. Nursing (Hons)Examination. mentioned above.

DECLARATION

I hereby solemnly and sincerely affirm that the statements made andinformation furnished by me in the application form and also in the enclosuressubmitted by me are true and correct. I have not kept any information secret.Should it, however, be found that any information furnished herein isfraudulent/incorrect or untrue in material particulars, I realize that I am liable tocriminal prosecution. I agree to abide by the Rules and Regulations governingthis examination and as contained in the instruction booklet. I understand thatmy admission will be provisional and if at any later stage, I am found ineligible,it will automatically stand cancelled.

Left Hand Thumb Impression Right Hand Thumb Impression

Signature of theCandidate

Verified by :

(Signature & Seal)

Date: ............................2011

Place: ...................................

Signature & Thumb Impression should be verified and marked in presenceof Principal of School/ College last attended/ Gazetted Officer/ExecutiveMagistrate.Note:Candidate must sign the form and affix Left & Right Thumb Impression failing which

the application form will be rejected.-5-


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RAJASTHAN UNIVERSITY OF HEALTH SCIENCES,JAIPUR

M.Sc. Nursing Entrance Examination 2011 - 12(for Admission to M.Sc. Nursing (2 Year) Course)

ADMISSION CARD

Roll No. (Leave Blank) ..............................................

[Candidate must fill in his/her name and fathers name in his/her own writing]

Pleaseadmit ..............................................................................................................................................

Son/Daughter of

Mr./Ms./ ...................................................................................................................

to the M.Sc. Nursing Entrance Examination 2010 - 11

AFFIX YOURRECENT





Officer

which will be held on 17.07.2011 (Sunday) 08.30 A.M. 11.30 A.M. at ExaminationCentre .................

(..........................................)

The ConvenorM.Sc. Nursing Entrance Examination 2011 - 12

INSTRUCTIONS

1. The M.Sc. Nursing Entrance Examination shall be conducted at Jaipur only. All candidates arerequired to appear at the M.Sc. Nursing Entrance Examination at their own expenses.

2. The candidates are expected to take their seats 30 minutes before commencement of theexamination. No candidate coming after 15 minutes of the commencement of theexamination shall be permitted to appear in the examination.

3. Candidates will be required to produce Admission Card before he/she is allowed to enterthe examination centre.

4. Candidates must bring two black ballpoint pens.

5. Candidates should read the instructions given on OMR Sheet carefully. All entriesmust be filled by ball point pen. Darken the appropriate circles/ovals using blackballpoint pen only. Therefore, the candidates are advised to finalize their choicebefore marking on OMR sheet. Overwriting is not allowed. If any candidate darkenmore than one circle, his/her answer will be treated as wrong. Darkening of morethan one circles/ovals will be treated as wrong. No stray marks should be made onthe OMR sheet. OMR sheet should not be folded. Rough work must not be done onthe OMR sheet. Whitener for correction is not allowed.

6. No candidate shall be allowed to carry any text material written or printed, bits of paper orany other material except the admission card inside the hall. Cellular/Mobilephone/Pager/Calculator or any other electronic device will not be permitted in theexamination hall.

7. The Candidates shall maintain silence and attend to their paper only. Any disturbance by the

candidates at the examination will be deemed as misbehavior and the candidates involved insuch activity shall forfeit their right to continue in the examination. The decision of the CentreSuperintendent shall be final and conclusive in the matter.

8. The University shall arrange for videography/photography of individual Candidates. TheCandidates are required to keep their head in upright position and face the camera duringthis process so that their identity could be clearly established.

9. In order to prevent impersonation, left thumb impression shall be obtained on a biometricmachine during the conduct of examination. In case left thumb impression could not beregistered on the machine due to injury or some other reason, right thumb impression orimpression of any finger, in case other thumb is also injured, shall be registered on themachine.


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10. No Candidates shall be allowed to go outside the examination hall till thecompletion of the examination.

11. Writing anything on the Admission card/Carbon copy of OMR sheet or any stray paper will betreated as unfair means. Candidates should not tamper with the question booklet or tear anypage out of it.

12. If the Candidates have any grievances regarding the ambiguities of the question paper, thesame can be submitted / sent to Office of The Convener, at RUHS, Jaipur up to 5.00 P.M. onthe date of examination or The Center Superintendent just after the completion of theExamination.

13.The Jurisdiction of the court cases will be atJaipur only.-6-

FOR IN-SERVICE CANDIDATESS ONLY

(TEACHING/CLINICAL)

1. Full

Name ................................................................................................

....................

2. Present designation and Place of

Posting ...............................................................

3. Date of Joining and

Place ..........................................................................................

AFFIX YOURRECENT


Candidates andattested



Officer

DECLARATION

I am serving the Government of Rajasthan continuously since .......................... and havecompleted two years after regular appointment in Government of Rajasthan. As such, I ameligible for admission to M.Sc. Nursing (2 Year) Course in In-Service category.

Dated...........................

Signature of theCandidates

CERTIFICATENo. Date:

This is to certify that

Sh./Miss/Mrs. .......................................................................................................................

Son/Daughter/W of ................................................................................. is posted

as ................................... at ...................................................... She/He was appointed vide

State Government Order No. .......................... dated .................................. and has been in

the State Government Service from ......................... to .............................. and has

completed two years.


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It is certified that he/she is eligible for admission to post graduate courses through theM.Sc. Nursing Entrance Examination 2011 12 under the In-Service category,Government of Rajasthan rules and other directives in force.

Date: ..............................

Place: .............................

DirectorMedical & Health ServicesGovernment of Rajasthan,

Jaipur(Seal)

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FOR IN-SERVICE CANDIDATESS ONLY

(TEACHING/CLINICAL)

1. Full

Name ................................................................................................

....................

2. Fathers

Name ................................................................................................

.............

3. Date of

Birth ..................................................................................................

..............

4. Address .............................................................................................

...........................

.........................................................................................

...............................

.........................................................................................

...............................

AFFIX YOURRECENT


Candidates andattested



Officer

5. Years of B.Sc. Nursing study from ......................................................

to ..................................................

6. Name of

College .........................................................................................................................

...................

7. University......................................................................................................................

..................................


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8. State .............................................................................................................................

....................................

Signature of theCandidates

Certificate to be given by the Principal of the Nursing College.

This is to certify tha

Sh./Ms .......................................................................................................

Son/Daughter of ................................................................................. has

studied in this institution w.e.f. ........................................

to ....................................... and passed B.Sc. Nursing, B.Sc. Nursing (Trained

& Registered) / Post Basic B.Sc. Nursing (Hons) Examination held

in ............................................. (Month) ......................................... (Year)

under Roll No. ................................. This College is recognized by the Indian

Nursing Council.

Date: ..............................

Place: .............................

PrincipalNursing College

(Seal)-8-

Template for Envelop

APPLICATION FORM FOR M.SC. NURSING ENTRANCE EXAMINATION 2011 -

12

LAST DATE : 2nd July, 2011


11/11

To,

The Convener, M.Sc. Nursing Entrance Examination2010-11

Rajasthan University of Health Sciences

Kumbha Marg, Sec. 18, Pratap Nagar, Jaipur - 302 033

From :

Name: _______________________________________________

Father Name: _________________________________________

Complete address : ____________________________________

_____________________________________________________

Phone : ______________________________________________

Cell No : _____________________________________________

E-mail : ______________________________________________

Note: -This form will not be accepted after 5.00 P.M. of 02nd July,2011

Documents

M.sc. Nursing Form