ONLINE APPLICATION FORM FOR
SENIOR PROJECT OFFICER (SPO)- HEALTH SYSTEM STRENGTHENING for eVIN Project

Position Code: SPO-HSS-MZ State(s) in Which Vacancies Exist: Mizoram (Aizawl)

1. Personal Details:

Applicant's Name:
Father/Husband's Name: Date of Birth:
Gender: Mobile No.:
Email ID: Alternate Contact No.:

2. Address:

Current City of Residence: City of Domicile(State):
Correspondence/ Current Address with Pin Code: Permanent Address with Pin Code

3. Qualification Details:

Name of Degree/Diploma
Specialization & Principal Subjects
Name of University/ Institute (City)
Passing Year
Marks (in %)/ GPA
MCI Registration (Only for Medical Qualifications )

4. Employment Details. (Please start with current/ most recent experience. If you have worked in more than one area/ post within the same organization, please enter details of the same separately):

# Name of Organisation Designation/ Title Key Responsibilities From To Location (City, State)
Current Employment Details:
1.
Other Employment Details:

5. Areas of Specialisation. (Please note that your response to this part of the application form shall be scored and qualitatively assessed to confirm your suitability for the post. We urge you to carefully fill your response and provide adequate details.):

# Name of Organisation Details of Key Job Responsibilities, Duties, Tasks Handled and/or Accomplishments to Demonstrate Relevance of Experience in Requisite Areas Duration of Experience (in months) Location (City, State)
 
1. Experience in policy-cum-programme development, monitoring & implementation at the district level or above. (Please fill details of your experience in the row below):
 
2. Experience in Routine Immunization programme including the vaccine logistics and cold chain mechanisms. (Please fill details of your experience in the row below):
 
3. Experience in managing information technology driven projects. (Please fill details of your experience in the row below):
 
4. Experience in Health Policy analysis and influencing. (Please fill details of your experience in the row below):

6. Present Salary and Allowances in INR lacs per annum. (Please use this section to report your present gross salary):

a. Annual Salary: b. Annual Allowances* if any. (Excluding components already included in a.): c. Gross Annual Salary and Allowances:
*Please exclude travel/ per diems and/or other allowances that comprise reimbursement of expenses incurred by you.

7. Computer Skills:

Application
 
(1) Proficiency in use of MS Office
a. Excel
b. Word
c. Power Point

8. Language Proficiency:

Language Read Write Speak
English
Khasi
Mizo
Ability and willingness to travel extensively, based on the needs of the job. Joining Time (in days):

9. Referees. (Please list three supervisors to whom you have reported professionally in the recent past, whom we can immediately contact for reference checking. Please note that reference checking shall only be initiated in case the applicant has been found suitable pursuant to final interview ):

# Name Address Email Phone Organization Designation Your Professional Relationship With and Year of Reporting to Referee
 
1.
 
2.
 
3.

10. Upload CV:

Certification: I certify that to the best of my knowledge and belief, the details submitted by me correctly describe my qualification, experience and other information, as requested by SAMS.