Application for the post of Medical Officer Survey

1.Full Name:(Required.)

2.Age:(Required.)

3.Gender(Required.)

4.Email Address :(Required.)

5.Mobile Number :(Required.)

6.Native place :(Required.)

7.Native State(Required.)

8.Current Location : City(Required.)

9.Current Location : State(Required.)

10.Language Proficiency(Required.)

English

Hindi

Telugu

Other (please specify)

11.Educational Qualification:(Required.)

1

2

12.Do you have a valid Medical Registration in Telangana(Required.)

Yes

No

13.Currently Working?(Required.)

Yes

No

If yes, Name of the Organisation, Location, and Designation :

14.Total years of working experience(Required.)

15.Total years of Experience of working in public health programs or projects(Required.)

16.Total years of clinical experience in a hospital(Required.)

17.Total years of experience in palliative care, chronic care, oncology, or geriatrics(Required.)

18.How do you rate your knowledge of palliative medicine, including safe opioid prescribing (morphine) and symptom management?

19.Do you have experience in community mobilization/community outreach activities(Required.)

Yes

No

20.Work experience (name the organizations you worked at in descending order)

1

2

3

22.Are you willing to travel for home visits with the project team in Hyderabad and Medchal Malkajgiri districts of Telangana (About 5 – 6 days a week)(Required.)

Yes

No

23.Are you willing to potentially work flexible hours(Required.)

Yes

No

24.Current Annual Salary

25.Expected Annual Salary

26.Upload your Resume/CV :(Required.)

No file chosen

27.Covering letter (optional)