14
PERFORMA FOR APPLICATION
To,
The Presiding Officer, Recent
Civilian Direct Recruitment Board, Passport size
CHQ, ASC Centre (South) – 2 ATC/ASC Centre (North)-1 ATC photo duly
Agram Post, Bangalore -07 self-attested
=============================================================================
1. Post applied for :_________________________________
2. Name of the Candidate (Full Name) :_________________________________
3. Mobile Number (Functional) :_________________________________
4. E-Mail ID (Functional) :_________________________________
5. Aadhar No :_________________________________
6. Father`s Name :_________________________________
7. Date of Birth (As per Matriculation certificate) :_________________________________
(DD/MM/YYYY)
8. Correspondence Address:-
House No/ Street/ Village :_________________________________
Post Office :_________________________________
District :_________________________________
State :_________________________________
Pin Code :_________________________________
9. Permanent Address:-
House No/ Street/ Village :_________________________________
Post Office :_________________________________
District :_________________________________
State :_________________________________
Pin Code :_________________________________
10. Educational Qualification : _________________________________
(Matric/ITI/Diploma/12th/
Graduation/Post Graduation)
11. Educational Qualification
Ser Qualification Name of Name of % of Remarks
No School/ College Board/ University Marks
Obtained
12. Gender (Male/Female/ Other) : _________________________________
13. Category (UR/ SC/ ST/ OBC/ : _________________________________
EWS/ PH/ ESM/ MSP)
14. If applied for the Post of Ex Serviceman : _________________________________
(Date of enrolment in Army/ Navy/ Air Force
and date of retirement and attach copy of
Discharge Book/ certificate/ NOC)
15
15 If applied for the post in PH category:-
Type of Disability Percentage of Remarks
(OH/ HH/ VH/ Mental illness/ Disability
Multiple disability) (40% and above)
Enclose Disability
certificate issued by
CMO/ Civil surgeon
of Govt hospital
certifying the
disability.
16. Whether registered with any : _________________________________
employment exchange
(If yes, mention registration No and Name of
employment exchange)
17. Whether employed in Central Govt Services : Yes/ No
(If yes, give details as per following format &
attach serving certificate duly signed by HoD)
Name of Name of Post Date of Serving since Office Address
employer Appointment
18. Name of the stations, a candidate wishes to be posted, if selected in the order of preference:-
(a) 1st Choice :________________________
(b) 2nd Choice :________________________
(c) 3rd Choice :________________________
=============================================================================
DECLARATION
I hereby certify that above particulars mentioned in the application form are correct and true to the
best of my knowledge and belief. I understand that in the event of any information being found false or
incorrect at any stage or not satisfying the eligibility criteria according to the requirements of the
advertisement, my candidature/ appointment is liable to be cancelled/ terminated. I am willing to serve
anywhere. I agree that department has the right to transfer me to anywhere in India.
Dated : ______________________
(Signature of the Candidate)
Place :
=============================================================================
Enclosures:-
(i) Two Self-Attested Photographs (Name & father’s name on the back side of photo).
(ii) One self-addressed registered envelope duly affixed with appropriate postal stamps.
(iii) Self-Attested copies of certificates (____ ) Sheets.
(vi) Admit Card in duplicate.
16
Appendix I
FORMAT FOR THE APPLICATION COVER (ENVELOPE)
APPLICATION FOR THE POST OF ---------------------
________ % (UPTO 50% IN RED INK ONLY)
PERCENTAGE IN ___________________
_________% (BETWEEN 51% TO 60% IN BLUE INK ONLY)
<
MATRICULATION/ (SIGNATURE OF THE
_________% (61% AND ABOVE IN BLACK INK ONLY) CANDIDATE)
EQUIVALENT
4¾ To,
Inch
11 Inch