Application Form

Computer related, if any). Name of Board / Institute. Duration of. Course. (in years). Month and Year. % of Marks. Obtained. Joining the course. Passing.
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APPLICATION FORM (To be filled by the candidate in his / her own handwriting in capital letters with black pen)

Candidates to affix recent passport size colour photograph

I hereby apply for the post of _______________________________________________ (Advertisement No. _________________________________)

Sign here (in the box) 1

Name of the Candidate (As recorded in the Matric / 10th Certificate)

2

Father’s Name

3

Postal Address for Communication (with PIN Code No.) P

4

E-mail ID

5

Contact No. Day

Date of Birth

I

N

Month

Year

6 Age as on 24.06.2014 7

Gender (please tick)

8

Category (please tick)

9

PWD / Ex. Serviceman (please tick, if applicable)

10

State of Domicile

……………… YEARS ……………. MONTHS MALE FEMALE SC PWD

11

Nationality

ST

OBC

GEN

Ex. Serviceman

12

Religion

13 ALL EDUCATIONAL QUALIFICATION (FROM MATRIC / CLASS 10th ONWARDS): Qualification : (Academic, Technical, Professional & Computer related, if any)

Name of Board / Institute

Duration of Course (in years)

Month and Year Joining the course

Passing the course

% of Marks Obtained

14 DETAILS OF EMPLOYMENT, IF ANY Name & Address of Employer

Post Held

Period of Service From To

Salary per Month

15 DETAILS OF APPLICATION FEE, IF APPLICABLE Demand Draft No.

Name of Issuing Bank

Date of Issue

I hereby declare that I have read all the conditions mentioned in the advertisement and I fulfill the same. The statements made in this application are true, complete and correct to the best of my knowledge and belief. I understand that in the event of any particular or information given herein being found false or incorrect, my candidature is liable to be cancelled and in the event of any mis-statement / discrepancy in the particulars being detected after my appointment, my service is liable to be terminated without any notice to me. Date: ……………. Place: …………………. Signature……………………… Note: 1. Candidates must write a) Advertisement No. and b) Post Applied For on the top of envelope containing application form. 2. Attested copies of the following documents must be enclosed with the application form (no other certificates to be attached): a. Matric / SSC / ITI / Semester-wise Diploma mark sheets, wherever applicable. b. Birth Certificate / School Leaving Certificate. c. Proof of Caste issued by Competent Authority in case of SC / ST / OBC candidate. d. Proof related to PWD candidate / Ex-servicemen Discharge Certificate, if applicable e. Demand Draft (if applicable) 3. Application received after due date would be summarily rejected.