GOVERNMENT OF WEST BENGALOFFICE OF THE SUB'DTVISIONAL OFFICER

KURSEONG, DARJEELINGKURSEONG: DAR^IEELING:WB -7 342o3

Memo No. 313/GEN/H/18 Date: 29-O5-2O18

NOTICE FOR ENGAGEMENT OT'ASHA

On behalf of the ASHA Selection Committee, Kurseong Sub-Division,applications are hereby invited in the prescribed form (Annexure A) from thepiospective and interested candidates for engagement as Accredited Social HealthActivist(ASHA) on purely temporary basis under NRHM for different areas under all theHealth Sub-Centres (attention: Annexure B) under Sukuna BPHC, KurseongDevelopment Block under Kurseong Sub-Division, in pursuance of the Memo

No.HFW/NRHM-652/t2llL62 dated 19lO3l2O18 of the Mission Director, NationalHealth Mission, fkalth & Family Welfare Department, Government of West Bengal.

Date of submission of application from 29-S-2OLA 6 l2'7'2O18.Time of submission of application from 11:OO a.m. to 3:OO p.m. on all workingdays except Saturday, Sunday and other holidays.Venue of submission of application form - Oflice of the Block DevelopmentOflicer, Kurseong.

Eligibility criteria for engagement to the post of ASHA:-

I Should be a married/ divorced / widowed woman'r Should be a permanent resident of the sarne area under the health sub-centre

for which she is aPPlylng.r As on O1.01.2O18 should be within the age group 30-40 yeal's. In case of SC/ST

candidates, the lower age limit may be relaxed to 22 years. (For all candidates,born not before 1-1-1978 and not after 2-1.-L987; for SC/ST candidates bornnot before 1-1-1978 and not after 2-1-1995)

! Should be Madhyamik or equivalent examination appeared, (either passed or

failed). Candidates possessing frigh.r qualilication are also eligible. However, inall cases (appeared and faiied or passed or possessing higher qualifrcation) only

the mart<s obtained in Madhyamik or equivalent examination will be

considered.. Areas where the majority of the population belongs to SC/ST, preference will be

given to candidates from that category, keeping the selection criteria fixed, by

the Sub-Divisional level ASHA Selection Committee'r preference will be given to Grade I & Grade II SHG Members/trained Dais/Link

workers, keeping the selection criteria fixed'

How to aPPIY:-prospectivi and interested candidates should frll up prescribed application form

(Annexuie A) in her own hand-writing with blue/black pen and enclose the following

document:-r Birth Certificate or Admit Card of Madhyamik or equivalent Examination (self

attested photocopy) as proof of age'

Contd.. ..page(2)

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z'. 2 zi

Voters Identity card (EPIC) and Ration Card ( Self attested photocopy) as proofof local residence.Marksheet of Madhyamik or equivalent Examination (Self attested photocopy),even in case of failure in exam.Self Attested copy of Marriage Registration Certificate in case of married womenor self attested copy of Decree of Divorce in case of Divorced women or selfattested copy of Death Certificate of Husband in case of widow.In case of above mentioned Certificates are not available, Self Declarationregarding marital status certified by E.A./Secretar5r and Health Supervisor ofconcerned G.P. in Annexure-C.Self Attested copy of Death Certificate of Husband for Widowed applicant.If applicable, SC/ST Certificate from competent authority (Self attestedphotocopy)If applicable, in case of Grade I & Grade II SHG Members, certificate from BDO,Kurseong and in case of trained Dais/Link -workers, certificate from BMOH,Kurseong at Sukna BPHC has to be submitted alongwith application form.Two (02) copies of identical Passport size coloured photo, one for applicationform and aqpther for Admit Card.An envelope (Size: 23cm X locm) with postal stamp of Rs 5/- affrxed and thefull postal address of the candidate written on.The envelope containing the Application Form and enclosures should besuperscripted as "APPLICATION FOR ENGAGEMENT AS ASHA, name ofsub-centre applied for and narne of area-" and should beaddressed to and to be submitted at, preferably by hand or via Speed Post orRegistered Post to:

The Block Development Officer,Kurseong Development Block.

At Kurseong BDO oflice.Pankhabari Road, P.O. + P.S. Kurseong

Dist. - DarJeeling, Pin-7 342o,3

Application by Whatsapp/e-mail/BDO Offrce drop box shall not be entertained.

Incomplete/erroneous application/un-signed application/application withoutany or all of the required documents shall be summarily rejected, and noconsideration in this regard shall be allowed.

Application received after 3:00 pm on l2-7-2O18 will not be entertained.

Applications received after due date and time due to postal delay or any otherreason will not be considered.

Interview will be held for the applicants fulfilling all criteria. The notice of date,time and venue of the interview will be sent to the applicant via post. Thedetails will also be available at Kurseong Block Office, Sukuna BPHC, all GramPanchayat Offices and Health Centres under Kurseong Block.

While applying the applicant should ensure that she fulfills the eligibility &norrns and that the particulars furnished by her are correct in all respects. Incase it is detected at any stage of selection that applicant does not fulfill anyeligibility norrns and/or that she has furnished any incorrect/fa-lse informationor has suppressed any material fact(s), her candidature will stand cancelledwith no further communication. If any of these shortcomings is/are detectedeven after selecLion her engagement is liable to be terminated without assigningany reason thereof.

I

I

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Contd. ..page(3)

.. 4D ....u..

r The ASHA Selection Committee, Kurseong Sub-Division will draft panel list sub-centre wise on the composite number of Marks in Madhyamik Examination andInterview.

r If any candidate fails to appear before the Interview board, her candidaturewill be summarily rejected even if she is otherwise eligible and has securedhighest marks.

I Engagement of ASHA is purely on contractual basis and this does not conferany right/privilege for regular appointment or continuity of service.

r Misconduct on the part of the candidate at any stage of the engagement processis strictly prohibited & shall render disqualification.

t The applicant shall not possess adverse Crimina-l Record which may render herunsuitable for the post.

r The original documents (except Self Declaration vrith Certificate byEA/Secretary and Health Supervisor of concerned Gram Panchayat regardingmarriage and Certificate regarding Grade-I/Grade-II/Trainned Dias/LinkWorkers) need not to be submitted.

r The self attested copy of the certificates will be checked/verified during theinterview.Hence the {ualifred/short listed applicants will be asked to bring the originaldocuments during interview or consequently for verification of self attesteddocuments.

General Conditions:

i. Carefully read the instructions mentioned above before applylng. Fill upApplication Form with due care.

2. Help Desk has been set up at the Kurseong BDO Office. Apart from this, theGram Panchayats/BPHCs/PHCs/Health Sub Centres under KurseongDevelopment Block have been briefed, too. They may be approached.

3. Submission of the application does not guarantee an appointment.4. In case of any misrepresentation of facts and documents, the applicant shall be

disqualified at any time and at any stage during the process of selection.Appropriate legal action may be taken against the candidate.

5. The Sub-Divisional Level ASHA Selection Committee reserves the right to alterthe mode of examinations or to conduct re-interview or to cancel part or wholeof any process of engagement including provisions/clauses of this notice orapplication at any stage, if required.

6. Biware of touts & job racketeers tryrng to deceive you by false promise(s) ofsecuring job as "ASHA" either through influence or by use of unfair means.Please beware of unscrupulous elements and do not fall in their trap. Anyattempt on the part of candidate to be selected by unfair means, requestthrough persons, officia-ls or agencies etc. will disqualify her candidature.

7. The decision of ASHA Selection Committee, Kurseong will stand frnal.

Enclosed: Annentre A: Application Form.Annentre B: Area taise ASHA uacancg under different health sub-centres of Sukna BPHC'

Kurseong DeueloPment Block.Annentre C: Self declaration bg tlrc applicant for ter marital slatus (Married/ Diuorced/Wdout) dulA

ASHA Selection CbmmitteeKurseong Sub-Division

&Sub-Divisional OfficerKurseong, Darjeeling

Contd..........Page (4)

,i

Member-

.. 4..

Memo No. 313( 161/GEN/H/ 18 Date:29-O5-2O18

Copy forwarded for information, necessa.ry action to:

l.Smt.ShantaChettri,Hon'bleMemberofParliament(RajyaSabha)andChairoerson of the ASHA Selection Committee, Kurseong'

2. The District Magistrate, Darjeeting.-. ftre envlc), Da-"rjeeling with ieques-l to cause wide publicity at her good office'4. The ADM(D), oarieeling with request to cause wide publicity at his good off,rce.

5. The ADM( (t-n) & Oistrict Land & Land Reforms Officer, Darjeeling with request tocause wide publicity at his good ofllce.

6. The Chief Medica.l Officer of Health, Darjeeling.7. The DIO (NlC), Darjeeling with a request to upload this in district website of Darjeeling

immediately.S. The DPHNO, Darjeeling with request to cause wide publicity.9. The DPO(ICDS),-Darjeeling with a request to brief the CDPO (Kurseong Rural) under

his jurisdiction to display same in the office and all the AWCs under his jurisdiction andto send a certificate to that effect to the undersigned within two days of receiving thisnotice.

10.The SDPO, Kurseong with request to cause wide publicity through local P.S. / OutPost.

11.The Block Development Officer, Kurseong with a request to.briefthe Cram Panchayatstaff accordingly, to advertise the above Notice in Block & Cram Panchayat Office, to setup a Help Desk for ASHA at the Block Office, to receive applications of ASHA withproper receipt, to maintain a register for applicants, etc. and to send a certificate to thateffect to the undersigned within two days of receiving this notice.

12.The BMOH, Kurseong at Sukuna BPHC with a request to brief the BPHC/PHC/HealthSub-centre staff accordingly and to display same in all BPHC/pHC/Health Sub-centrewithin his jurisdiction and to send a ceitificate to that effect to the undersigned withintwo days of receiving this notice.

13.The-lr Co-ordinator, IT Cell, Swasthya Bhawan, GN-29, sector-v, Salt Lake, Kolkata -700091 with a request to upload this notification in the website immediatelv.

14.The Sub- Divisional Information & cultural officer, Kurseong ,tiith requesl tocause wide publicity.

15.The Station Director, Arl India Radio, Kurseong Station with request to cause widepublicity.16. Oflice Notice Board.

Kurseong Sub-Division&

Sub-Divisional OfficerKurseon& Darieeling

Annexure-AAPPLICATION FORM fOT ASHA-2018

[Please fill the application form in CAPITAL LETTERS in own handwriting with Black/ Blue ball point pen)

For Office Use onlyReceived on ....../ ...../201.8

Index No:

Roll No:

Date of Birth

ToThe Member Secretary,ASHA Selection Committee,Kurseong& Sub-Divisional Offi cer,KurseongDarjeeling, West Bengal

Sub: Application for engagement as ASHA

Ref: Notice Vide Memo No. 313/Gen/H/1'B dated 29.5'201

Age as on 01.01.2018: ............. Years months

Paste self attestedrecent colourpassport size

p hotograph of theapplicant

Name in full:

I I I I

DDMMYYYYName of the Sub-Centre applied for: ......... ..'...... Area applied for: '..'.......-.

MaritalStatus:(Pleasewrite,.YES,,intheappropriatebox)Married:l_-lDivorced:|---tiaowed:

Husband's name: .................:{

Address: Village .... G.P. """"' P'O'

Distance of house from the Sub-Centre (in metres)category: sc l--l sr [-l General f_JSC/ ST Certificate No [if applicable) Ration Card No......

Details of Madhyamik uivalent examination:o

Name ofExamination

Year ofAppearance/Passing

Board/Council Total Marksofthe Exam

Iexcludingadditionalsubiectl

Total MarksObtained

Iexcludingadditional subjecti

o/o of Marksobtained)

Madhyamik orequivalentExamination

Enclosures: 1-Birth Certificate -or

Admit Card of Madhyamik or equivalent Examination (Self attested photocopy)

2. Voters Identity card (EPIC) and Ration Card (selfattested photocopy)

3. Marksheet and Admii card of Madhyamik or equivalent Examination (Self attested photocopy)

4. Marriage Certificate / Decree of Divorce / Self-Declaration on Marital status (in Annexure-C) certified by EA/Secretary and

Health Supervisor of concerned Gram Panchayat.

5. If applicable, SC/ST Certificate (Self attested photocopy)

o. tf applicaule, Certificate from appropriate auihority, ln iase of Grade I & Grade Il SHG Members and trained Dais/Link -workers.

Declaration: I have read carefullythe notice and understood it fully. I do declare that all the statement made on this application are

true, complete and correct to th; best of my knowledge and belief. In the event of being the above information found

false/incorrect at any stage, my candidature is liable io be cancelled forthwith. This is also to certify that I have no criminal record

anywhere and if any criminal iecord is found my candidature will be summarily rejected even I get selected for the post'

I am fully aware that the engagement is purely iontractual and Temporary and I shall not claim for permanent engagement by

virtue ofthis in future.

Place :

Date : Full Signature of the APPlicant

'ci

VACANCY OF ASHA IN KURSEONG DEVELOPMENT BLOCK

ANNEXURE. B

ST, MARY'S -III

SL,No_

NAME OF SUB.CENTRE NAME OF VILLAGE/AREA NAME OF G P Vacancy for ASHA

1 SUKNA

SUKNA

SUKNA

CHOTA ADALPL]R '|

2KOKLONG F VANAMSH BUSTY

CHAMPTA F,V1

KHAIRENI F,VPUNOING F V 1

SIMULBARI T E 3

1

2 CHUNABHATTI

CHUNABHATTI

GHAYABARI .II

1

KOTHIDARA

KOPCHEY GAON 1

2, NO, SABIRTI BUSTY 1

RONGTONG1

SEPOYDHURA T ESHIVAKHOLA 2

JTE 2

PANKHABARI

KOTI.,lIDARA

DURPIN

IHALIPAKHA1

BIMITAR

CHILAUNEY DHUM 1

PANKHA BARI

CENTRE LINE

SCHOOL -DARA

NAYA GAON

RAMHATTI

NEW LINE

1

1MUNSHI GAONGURDUNGVELLACOOP 1

5NO 1

HOAPITAL LINE 1

PLAIN LINE1

GODAMDHURA

34 NO.'|

KALIKHOLA

4 SANKER NIWAS

SANKER NIWAS

GHAYABARI .II

1

GOLAI PAKHA 1

GAIRY GAON117th MtLE

BHANU GRAMOLD HOSPITAL & BARAKHOTI

1

RAMGARH

TINDHAREY T.E 1

LAPCHEYKHETI

GHAYABARI -III

1

-APCHEYTAR]HISOPANI 1

THAROGAON13AIRIGAON

ALEYTOP

1N4ANEYKHOP

RATNEYDYANG

I\4ARCHEYBONG

JABARHATT 1

PAILADHURAGHAYABARI.I

1

KOTHIDARALOWER SIRUBARI(Below poultry

1

LOWER SIRUBARI

6

rARUA & DAMPHEYTAR

ST, MARY'S.1II

1

RAI GAON 1

DUDHIA 2

MARIONBARI T.E. 3

AMRIT BUSTY 1

BAMON POKHARI 1

3ARIDHURA 1

SIPTIGURI SUKNA 1

DUDHAI

7 MAHANADI

TRIVENI CHOWK

MAHANADI

1GUMBADARA

GAIRIGAON

CHETTRI GAON

1BOOGTHING DARA

12.No.

BIRTALEY TAR

SHIVATAR

1

SHIVAKHOLA

GODAMTARTERES GAON

5. No

MUNSHI GAON1KOTHIDARA

10. No.

KHANI

3GHOOMTI T.E.

MAHANADI 1

63. LINE 1

8 RAJBARI

RAJBARI

GHAYABARI .II

1SCHOOL DARAHOTEL GAIRI

CRICKET BAZARBHANJYANG

1

MITHAIDARA

NAYAKAMAN GHAYABARI -II 1

.b.

I GHAYABARI

3HAYABARI

GHAYABARI .III

3

14th MtLE

1)AGLAJHORA

(ALIMATI 1

SELIM HILL 1

JOGMAYA I3AGMARA MAHANADI 1

,q

1

10 GIDDHAPAHAR

BORBONG

GHAYABARI - I

1

UHANDU BUSTY1

UIUUHAPAHAR2

1

GOURI SHANKER 2GWALA BUSTY

SAMSHER BUSTY

1MANDIR BUATY

NAYA BUSTY1

SIRUBARI BUSTY1

l1 CHIMNEY

CHIMNEY

CHIMNEY-DEORALI

16th MILE

SIMANATAR

1

DEORALI

SHAITAYPANI

3rd MILEKHUNDRUKAY

1CHITRAY

MAJUA1

TITENEE

JANGPANA T E MAHANAOI 2

12 ST. MARY'S

DHAREN GAONG

ST. MARY'S.II

1SUSIL GAONGSIRI GAONGR.VILLA TP CHURCH RD.

1BEECH GAONGLOOP.4

JHUbIKHULA

i

Ii

{

I

I

I

13 SINGELL

KOTHIDHURA

ST. MARY'S .II

1MALIDHURA

SULEEKHOLANAYADHURA

18Th No.

7Th No.

5 DHURAY14 DHURAY

SARKEEDHURA

2No

1

3 No.

t No.

]RECHE PAKHA(ILLKHAN

14 KHAHARAY

LOWER KHAHARAYST. MARY'S - II

1

IVIIDDLE KHAHARAY 1

GOETHALS 1

SEPOYDHURA

ST. MARY'S - I

1

LOWER CHAITAYPANI

BHOTE BUSTY 1

EDEN VELL 1

t.T.l.'lTUNG

15 RINCHINGTONG

DARA DHURA

ST. MARY'S.II

'lSIMANA DHURA

.AP$ BOTAY

SOOAT.,T DHURA

NAYA DHURA

KHAMARAY 1

KAIBARI 1

BHATTI KALITAR 1

GAIRI GAONG

PANCHGHARAY AMEOTIAPANOU

1

KOTHIPAKHA AMBOTIA1

KALIDHURA AMBOTIA

,i

16 MAKAIBARI

SPRING SIDE

PANOU

1

IHULOPATHLAY1

SANUPATHLAY

1PHUSDHURAH. KOTHI

THAPATHALI1

CHEPTAY

1KAILAPANI

SAAT GHOOMTI

KODOBARI1

PHULBARI

MAKAIBARI1

17 DILARAM

]HATTAKPUR

ST. MARY'S.I

1JPPER DILARAM

-OWER DILARAM13EECH GAONG

-APCHEY GAONG

1BHOTAY GAONGLOCATION

ARINGALAY1

GAIRI GAONG

M1AHARANI T.E, 1

BELOW ARINGALAY

1BELOW GAIRI GAONG

SELOW TUNG

BELITAR1FAZI

18 AMBOTIA

BASSURI I,l

BASSURII 1

GODAM DHURA

1SCHOOL DARA

DHOBIKHOLA GAON

HASPOKHARI

1DABAIKHETI

KUMALTAR GAON

IAR GAON1

JAGSING GAON

U/ SIRISEY1

U SIRISEYSIGN BOARD 1

.ALMATI 1

\

PANDU

SITTONG - II

22 LATPANCHAR

KARMAT F.V

srTToNG - ill

1

45/3 DHURA

1

GANDHI GRAM

RASIK/ MEROJ

PRAVAT TOLE

]HOBI DHURA(OTHI DHURA

1

SITTONG F. V

JHOLEY F.V 1

48 DHURA 1

GANESH DHURAJs ACRE1

72 DHUMMILAN DHUM

112 DHURA

SUMBA DHURA

in n,trre r v 'l

23 MALOOTAR

GODOWN DHURA

SHIVAKHOLA

1

GAIRI GAON)ANGRAY KHOLA 1

DAKBUNGLOW 1

FAGUTAR 1

UPPER SIMRING 1

SIMRING BUSTY

SHIVAKHOLA 5 NO.

GITANGEY MAHANADI 1

MAHALDIRAM T.E SITTONG.II 1

t

24 LANKU

zOTh MILE

SITTONG.III

1

KANDUNG 1

UPPER LANKU 1

LOWER LANKU

JPPER ROLAK,|

TOWER ROLAK

I\iIIDDLE ROLAK 1

nU \t

1

1

Annexure-C

I Smt

Self {eclar.ation by the applicanI tor her marital statusf Married/Divorced/Witlow).

D/O, W/O

presently residing at

have applied myself for the post of Asha for (area) under (sub centre).

I hereby declare that:-

l. I am aresident of

2. I am married to Shri S/o

resident of

for the last vears.

oR.

3. I am widow of late

resident of who expired on

OR

4. I am separated frorn my husband Shri

S/o for the last years.

This is true to the best of my knowledge and belief and I have not suppressed any facts while giving the above declaration'

Date:-

Place:-Full Signature of the aPPlicant.

This is to certify that the above mentioned information has been verified and it is true to the best of my

knowledge.

Signature of the Health SupervisorSignature of Executive Assistant / Secretary

Gram Panchayat

S/o

Seal

Gram PanchaYat

Seal of the Gram PanchaYat

,,'