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Nurses' Application Form For COVID-19, Mumbai
To be filled in by qualified nurses for services required for COVID-19, Mumbai
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* Indicates required question
Email Address
*
Your answer
Salutation
*
Mr.
Ms.
Mrs.
First, Middle, Last Name
*
Your answer
Residential Address (House/Flat No., Building No/Name, Society Name, Street Name, Suburb Name, Taluka, District)
*
Your answer
PIN Code (6 Digit India PIN Code)
*
Your answer
Contact Number (10 Digit Mobile Number)
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Female
Male
Other:
Qualification
*
Bachelor of Science in Nursing (B.Sc. Nursing)
General Nursing and Midwifery (GNM)
Other:
Year of Passing Qualifying Examination
*
Your answer
Nursing Council Registration Number
*
Your answer
Work Experience in Months
*
Your answer
Work Experience Details
*
Your answer
Willingness to Work on Contract Basis
*
Yes
No
I agree to work in COVID-19 patient's ward
*
Yes
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