APPLICATION FORM

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Advt.No. : 2. Post applied for : 3. Name (IN CAPITAL LETTERS) : 4. Father's/Husband's Name : 5. Date of Birth : (dd/mm/y
APPLICATION FORM

Affix Photograph 1.

Advt.No. : _______________________

2.

Post applied for : ____________________________________

3.

Name (IN CAPITAL LETTERS) : __________________________________________

4.

Father’s/Husband’s Name : _______________________________________________

5.

Date of Birth : (dd/mm/yy) _____________Day __________ Month __________ Year

6.

Age as on 30.09.2011 : ____________Days ________ Months __________ Years

7.

Nationality: _____________ 8. State of Domicile (state belongs to) : ________________

9.

Category (SC/ST/OBC) : ___________________________________________________

10. Whether Physically Handicapped/Ex-Servicemen ________________________________ 11. Sex (Write Male/Female) : ___________________________________________________ 12. Complete Correspondence Address: ____________________________________________ _______________________________________________________________________ _________________________________________________________Pin ___________ 13. Phone/Mobile No. ___________________ e-mail ID ____________________________ 14. Qualification (High School onwards) : Name of Exam. Passed

Name of Institute/University

Duration of Course

Date of Admission (DD/MM/YYYY)

Date Passing

of

Percentage of marks obtained

(DD/MM/YYYY)

15. Work Experience: Name & Address of the organization/employer

Post held

Period From

To

Nature of Job

Salary drawn

Reason for leaving

16. Choice of Language of Test/Interview: Hindi/English (Please tick) 17. Demand Draft No. : _______________ Dated ______________ Bank: _______________ I hereby declare that the above information is true to the best of my knowledge. I understand that my candidature will be cancelled, if the information is found to be false or incorrect or my application is incomplete. Date: ______________

(Signature of candidate) Also visit our Website http://www.iocl.com