Please affix
your
Photograph
here
SPICES BOARD
APPLICATION FORM
Pay Band/Scale
Name of the Post Applied for
(Kindly refer to the vacancy notification for details)
1. Name in full (BLOCK LETTERS) (Please leave a blank space between words)
SEX: Tick
Appropriate
Box
Shri Smt. Ms Dr.
2. Date of Birth(*)
M F
D D M M Y Y Y Y
2.a Religion
3. Please indicate the Category to which you belong(*)
SC
ST
OBC
Non-creamy layer
4. Name of father/guardian
5. Mother Tongue
5A. Nationality/citizenship
5B. Marital Status
6. Address for Communication (BLOCK LETTERS) (Please leave a blank space between words)
CITY
STATE
Telephone/
Mobile No.
E Mail
GEN
7. Permanent Address: (in block letters) (Please leave blank space between words)
CITY
STATE
Telephone/
Mobile No.
8.
Are you eligible for relaxation of upper age limit. If so,
give details.
9.
Are you entitled for weightage on grounds of being ex-service
Man or physically handicapped.
(If Yes, give details separately)
10.
Test Centre selected
(Kindly refer vacancy notification for details)
Yes
Yes
No
No
11. Particulars of Educational Qualification (in reverse chronological order) (*)
Name of
Subject
Examination
University
Year of
passing
Percentage of Class
Marks/OGPA
(*) Original certificates in proof of age, caste & educational qualifications may be produced at the
time of test/interview.
Rank if
any
12. Please furnish the details of experience and enclose supporting documents
Sl
No
Name of
Employer and
address
Name of position
and whether
Ad-hoc / temporary/
regular
Date of
Joining
Date of
Leaving
Experie
nce in
months
Salary
Drawn
13. Details of specialization in case of higher qualification/
Doctorates
14. Have you applied for any other post earlier as
per Boards notification?
Yes
15. Are you employed on regular basis under State/Central
Government.
16. Have you been debarred from recruitment by State/
Central Governments/Public Undertakings or dismissed
from service or convicted by Court of Law.
Yes
- .
b) Demand Draft Number - .
c) Date of Demand Draft - .
d) Issuing Bank
18.
- ..
Any other relevant information the candidate
wishes to mention:
Enclosures:
[Link].
1
2
Document
Demand Draft
Caste Certificate (if required)
Yes
No
No
Yes No
17. Demand Draft (DD) details:
a) Fees (In Rs.)
No
Nature of
duties
PH Certificate (if required)
DECLARATION
I, hereby declare that the information furnished above are true, complete and correct to the best of my
knowledge and belief that I am in possession of the documents in proof of the claim made in this application.
Date:
Place:
Signature of the candidate