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ARMY Dental Corps SSC Application Form

Author: SSC, Posted on Thursday, July 29 @ 10:38:54 IST by RxPG  

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Dental

The application form for grant of Direct Permanent Commission / Short Service Commission in the Army Dental Corps

(USE BLOCK CAPITAL LETTERS ONLY)

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1. Name in full: ........
(as per matriculation certificate)


Name in Hindi: ........


2. Date of birth: ........


3. Age as on December 31, 2004: ........years ........ months ........ days


4. (a) Father's name: ........


(b) Details of spouse (i) (Name): ........

(ii) Nationality: ........


5. Postal address


with pin code: ........

Phone no with STD code: ........


6. Permanent address with pin code: ........


7. Name of college and university from which BDS (MDS) was passed: ........



8. (a) Date of passing BDS (and MDS): ........

(b) Number of attempts taken in final BDS: ........


9. Marks and percentage obtained in final BDS: ........


10. (a) Is the college from which you passed BDS recognised by the DCI?: ........

(b) Is the college from which you completed internship of one year recognised by the DCI? : ........


11.Date of completion of internship: ........


12. Permanent Dental Registration Number, issuing office, valid up to: ........


13. Particulars of present employment: ........


14.Type of commission applied for -- DPC / SSC/ Both*: ........


15.Have you appeared earlier for commission in the Army Dental Corps? If yes, give details: ........


I hereby declare that all the statements made in the application are true and correct to the best of my knowledge and belief.



Date: ........ Signature of the candidate

Important

1. Copies of the following should be enclosed:

(a) BDS (MDS) degree

(b) Matriculation certificate (date of birth certificate)

(c) Dental Registration Certificate duly renewed up to December 31, 2004

(d) BDS final mark-sheet

(e) Internship certificate

(f) Two additional attested, passport sized photographs

(g) Any other relevant documents.

2. Enclose one self-addressed post card and one self-addressed envelope of size 23 cms x 10 cms affixed with Rs 22 worth of stamps for reply by registered Post.

Note: * Strike out whichever is not applicable.

Candidates applying for both must submit separate applications for DPC and SSC.



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