Employees State Insurance Corporation New Delhi Recruitment 2010 Application Form :

(A) Applicants for the post of Specialist Grade - II (Junior Scale) may obtain blank ESIC application form from the office of Senior State Medical Commissioner (S.S.M.C.) / State Medical Commissioner (S.M.C.) of the state concerned at the addresses given below and submit the same complete in all respect in the office of the S.S.M.C. / S.M.C. of the state in which the candidate intends to apply.

The blank ESIC application forms can also be obtained by post. All requests for blank ESIC application forms by post should be accompanied by a self-addressed and stamped (affixing postal stamps worth Rs. 25/- on envelope of size 35 cm X 15 cm) along with a Demand Draft of Rs. 200/- (Rs. 100/- for SC / ST candidates) drawn in favour of ESI Corporation issued from any scheduled bank and payable at the place where the request of the form is being sent.

Payment by any other mode of payment for issue of ESIC application form will not be accepted nor amount refunded.

Blank ESIC application forms can also be obtained in person from the office of the said SSMC / SMC on payment of Rs. 200/- (Rs. 100/- for SC/ST candidates) by way of Demand Draft as mentioned above.

Blank ESIC application forms will not be available from the Hqrs. Office of the ESI Corporation, New Delhi.

S. No.	Region in which ESIC vacancies are notified.	Address of the SSMC / SMC from where forms may be obtained and to be submitted.
01	Haryana (For Manesar & Gurgaon)	State Medical Commissioner, ESI Corporation, Regional Office, Panchdeep Bhawan, Sector 16, Faridabad - 121 002, (Haryana).
02	Rajasthan (For Bhiwadi)	State Medical Commissioner, ESI Corporation, Panchdeep Bhawan, Bhawani Singh Marg, Jaipur - 302 001, (Rajasthan).
03	Himachal Pradesh (For Baddi)	Sr. State Medical Commissioner, ESI Corporation, Panchdeep Bhawan, Block No.3, Sector 19 - A, Madhya Marg, Chandigarh - 160 020, (Punjab).
04	Jharkhand (For Adityapur)	State Medical Commissioner, E.S.I. Corporation, ESI Hospital Campus, Namkum, Ranchi - 834 010, (Jharkhand).
05	Andhra Pradesh (For Sanath Nagar)	Senior State Medical Commissioner / State Medical Commissioner, E.S.I. Corporation, Regional Office, 5-9-31/1/B, Opp. Old Gandhi Medical College, Basheerbagh Main Road, Hyderabad - 500 063.

Completed ESIC applications along with attested copies of certificates are to be sent in a cover superscribed "ESIC application form for the post of Specialist Grade - II", State Applied For __________", Specialty Applied For ____________________" by Registered Post / Speed Post so as to reach the office of Sr. Senior State Medical Commissioner / State Medical Commissioner latest by __________________________.

Candidates are advised to go through the "Instructions" attached to the prescribed ESIC application form before filling up the form. (Instruction No. 6 of the form stands deleted).

(B) Applicants for the post of IMO Gr.II & Dental Surgeon may apply in the form appended below.

ESIC application form complete in all respects and enclosing attested copies of all essential certificates in a cover superscribed ESIC application form for the post of __________, State Applied For ____________", by Registered Post / Speed Post so as to reach the office of Senior State Medical Commissioner / State Medical Commissioner at the above mentioned addresses as per following instructions.

The following testimonials etc. should be attached with the ESIC application form :

(a) Two copies of recent passport size photographs duly attested by Group 'A' / Group 'B' Gazetted Officer, with one photograph pasted on the ESIC application form.

(b) Attested copies of certificates and testimonials in proof of age / date of birth, educational qualifications and experience etc.

(c) Attested copy of community / status certificate in prescribed form in case of candidates belonging to SC / ST / OBC / PH / Ex. S.M. category.

Candidates claiming reservation / age relaxation on the grounds of belonging to OBC should submit the community certificate by vide Govt. of India, Deptt. of Personnel & Training O.M. No. 36012/22/93/Estt. (SCT) dated 15-11-93 failing which the benefit of reservation or age relaxation will not be given.

(d) Two self addressed envelopes of size 23 x 10 cms. Candidates employed in Govt. / Semi Govt. / Autonomous bodies should send their ESIC applications through proper channel.

However, they may send an Advance Copy of their ESIC application form along with demand draft and other certificates and testimonials before the stipulated date.

ESIC application form has to be submitted along with a Demand Draft as detailed below :

(For candidates applying for the post of IMO Grade - II or Dental Surgeon).

S. No.	Rate of Charge	For General / OBC Candidates	For SC / ST / PH / Women Candidates
(i)	Examination fee	Rs. 200/-	-
(ii)	Postal Charges	Rs. 25/-	Rs. 25/-
	Total	Rs. 225/-	Rs.25/-

The D.D. should be drawn in favour of 'E.S.I. Corporation' issued from any scheduled bank, payable at the state in which the candidate intends to apply.

Payment of fee by any other mode will not be acceptable.

Note 1 : The ESIC application form and other documents should be arranged in the following order, one below the other and tagged tightly or stappled on the left hand side top corner :

1. Two additional photographs.
2. ESIC application form.
3. Attested copies of certificates.
4. Self addressed envelopes.

Note 2 : The demand draft should not be tagged or stappled but should be pinned or clipped at the top of the ESIC application form.

The name and address of the candidate and the post applied for should be written on reverse of the demand draft.

Last date of receipt of ESIC Application Form : 15.06.2010.

Last date for receipt of ESIC application from candidates residing in Assam, Meghalaya, Arunachal Pradesh, Mizoram, Manipur, Nagaland, Tripura, Sikkim, Ladakh Division of Jammu and Kashmir State, Lahaul and Spiti District and Pangi Sub-Division of Chamba District of Himachal Pradesh, Andaman and Nicobar Islands and Lakshadweep will be 29.06.2010.

ESIC New Delhi Medical Officer Recruitment 2010 Application Form