User talk:Gothankarn

Greater Baltimore Medical Center School of Radiography 6701 N. Charles Street Baltimore, Maryland 21204 APPLICATION FOR ADMISSION Deadline for receipt of application is January 5, 2007 FOLLOW DIRECTIONS CAREFULLY 1. Type or print legibly all information. 2. Attach check or money order for $25.00 payable to: Greater Baltimore Medical Center 3. Failure to answer all questions completely or failure to submit an application fee will be grounds for disqualification of the applicant. 4. Request all previous high school and college (if applicable) transcripts to be sent directly to the School of Radiography. A. Personal Data 1. Name: Gothankar Nilesh Gopinath Address: 21/1620, MHB colony, Gorai Road, Borivali (West), Mumbai 400042, Maharashtra, India 2. Social Security Number: ___________________ 3. Contact: Home:(9869009218 )_________________Work:( 9869009218) 4. E-mail: ngothankar@hpiinc.com

B. Education List all high schools, colleges or other schools attended with most recent first: Please include any other name that may appear on the transcript. College/School	Location	Dates Attended	Degree and/or Diploma St. Francis D’Assisi High School 	Mumbai	June 1993-March 1994	X Standard Ismail Yusuf College 	Mumbai	June 1995-March 1996	XII Standard Ismail Yusuf College	Mumbai	May 2003	BSc. Chemistry

C. Employment List your last three employers beginning with the most recent:

Dates of Employer	Address	Position	Dates of Employment	Reason for Leaving	Supervisors Name and Phone Number P.K. Enterprise	Dadar, Mumbai 	Sales Executive	June 97 to June 98	To complete Graduation Source MT	Andheri Mumbai	Medical Transcription	December 2000	To complete Graduation HealthPrime Service Pvt. Ltd	Andheri Mumbai	Medical Transcription/Shift incharge	March 2004 till date

D. Health Care / Radiology Experience Have you had any previous healthcare / radiology experience? If so, where and When?

No.

E. Letters of Reference All applicants are required to submit at least three letters of reference. Applicants must request a letter of reference from your current employer in addition to two other individuals who have known you for three or more years. Letters of reference may not be from a relative. F. Personal Statement On a separate piece of paper, in 250 words or less, state your career goals and why you have chosen a career in health care.

I hereby certify that all information given in the above application is true and complete to the best of my knowledge. Falsification of information will result in denial of acceptance into the GBMC School of Radiography. I understand that admission into the School of Radiography requires adherence to all hospital and school policies and regulations. If accepted into the School of Radiography I agree to have a medical examination at GBMC during admission / enrollment.

Signature: Nilesh G. Gothankar________________________Date:  10/09/2006 How did you hear about our program? The Greater Baltimore Medical Center School of Radiography does not discriminate on the basis of age, sex, race, color, national origin, marital status religion, or handicap.

--Gothankarn 21:03, 15 February 2007 (UTC)