APPLICATION FORM – ADVT NO.
01/2014
VAVEL COMPONENT COMMANDER, HQNAVC, C/O NAVY OFFICE
HADDO (PO), PORT BLAIR-744102
Application for the pest of CMD/FED/Fireman
1. Name of the candidate (To be filled in capital letters only)
2. Father’s Name
3. Date of Birth:
4. Permanent Address
Line 1
Line 2
Line 3
State Pin code
Telephone
Mobile No:
5. Address for correspondence
Line 1
Line 2
Line 3
State Pin code
Telephone
Mobile No:
6. Caste/Category :
(Please tick() SC ST OBC Ex-Ser UR
7. Nationality : ...........................................................
8. Marital Status : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .
9. Religion :............................................................
10. (a) Educational Qualification (Essential Qualification onwards)
Qualification University/Board Year of Total marks Percentage Div/Class
passing secured of marks
(b) Technical
i. Heavy Driving License No : .....................................................
ii. Date of issue : .....................................................
iii. Valid up to : .....................................................
iv. Name of issuing Authority : .....................................................
11. Experience:
Post Held & Pay Period of service Total period in
Office / Institute Nature of duties
Scale From To years & Months
DECLARATION
(a) I hereby declare that all the statements made by me in the application are true, complete and correct to the best of
my knowledge and belief. I have not suppressed any information. I understand and agree that in the event of any
information being found false or incorrect or incomplete or ineligibility being detected at any point in time before or
after selection/interview, my candidature is able to be rejected. I shall be bound by the decision of the competent
authority.
(b) I have informed my Head office/Dept. in writing that I am applying for this post.(strike if (b) is not applicable)
Place :
Date :
(Signature of the candidate)