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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)
rT
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
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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
,,'
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