APPLICATION FORMAT
(To be filled by the Candidate in his/her own handwriting in capital letters with BLACK PEN
I hereby apply for the post of ________________________
Advertisement No.__________________________________)
Candidates to
affix recent
Passport Size
colour
photograph
Sign here (in the box)
1
Name of the Candidate
( As recorded in the Matric/High School
Certificate
Parents Name
2
3
Candidates to affix recent Passport Size colour photograph
Postal Address for communication (with
Pin Code No.)
P I N
4
Email id
5
6
Contact No.
Date of Birth
Day
Month
Age as on (31.12.2014)
Year
Candidates to affix recent Passport Size colour photograph
..Years Months
Male
Female
Gender ( Please Tick)
Category ( Please tick)
PWD/Ex. Serviceman (please tick, if applicable)
10
13
State of Domicile
Medium for taking written test (Hindi /
English)
SC
ST
OBC
PWD
11
GEN
Ex. Serviceman
Nationality
12
Religion
[Link] Educational Qualification ( Matric/Class Xth Onwards):
Qualification ( Academic,
Technical Professional &
Computer related, if any )
15.
Name of Board/ Institute
Duration of
Course
(in years)
Month and year
Joining the Course
% of Marks
obtained
Passing the Course
DETAILS of EMPLOYMENT, if any
Name & Address of Employer
Post held
Period of service
From
16.
DETAILS OF APPLICATION FEE, IF APPLICABLE
Demand Draft No.
Name of Issuing Bank
Salary / month
To
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
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.
The application must accompany attested copies of the following certificates (No other documents to be attached):
a)
b)
c)
d)
e)
3.
Matric /SSC /ITI/ Semester-wise Diploma Marks sheets (wherever applicable)
Birth certificate / Certificate bearing date of birth issued by School Board
Proof of caste issued by Competent Authority in case of SC/ST/OBC candidate
Proof related to PWD candidates / Ex-servicemen Discharge certificate, if applicable
Demand Draft ( if applicable)
Application received after due date would be summarily rejected.