POST APPLIED DETAILS
Name of Post for which application
PHOTO
form is being submitted
Advertisement No. & Date:
CANDIDATE PROFILE
Applicant's Name (In Block Letter)
Father's/Husband's Name
Mother's Name
Date of Birth
Age (as on 02.01.2025)
Gender
Category
Category Applied for
Marital Status
Religion
Nationality
Whether a person with disability (Yes/No)
Aadhar number
E-Mail ID
Mobile no.
ADDRESS
Address for Communication
Permanent Address
Use Separate sheets wherever necessary
Page 1 of 4
QUALIFICATION DETAILS
Exam Name Subject Passing University Institute/College Percentage Division/Grade
studied Year /Board Name
Birth Certificate/
10th Marksheet
(For DOB Proof )
12th
ITI
Diploma
Graduation
Post Graduation
Others
OTHER RELEVANT INFORMATION
Prizes/ Medals/ Awards Distinction
Workshops/Trainings
Sports and Extra-curricular activities (including NCC/
NSS)
Languages known
Level of Computer Proficiency
Are you Meritorious sports person? (Yes/ No)
Details of Published papers
Any other relevant details
Use Separate sheets wherever necessary
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EXPERIENCE DETAILS
Organization Post From date To date Duration Pay Nature of Temporary/ Reason
Name Name Responsibilities Contractual of
/ Regular/ Quitting
Permanent
DETAILS OF PRESENT EMPLOYMENT AND EMPLOYER'S ENDORSEMENT (CANDIDATE MAY
PRODUCE NOC IN LIEU OF THIS ENDORSEMENT AT THE TIME OF INTERVIEW) (if applicable)
Name of Organization
Designation Date of Appointment
Whether Temporary Nature of Work
/Contractual/ Regular/
Permanent
Total Pay Drawn
NAME AND ADDRESS OF MINIMUM TWO REFERENCE (REFEREES SHOULD BE FAMILIAR WITH
YOUR ACADEMIC/ PROFESSIONAL WORK AND SHOULD NOT BE RELATIVES)
Reference Name 1 Details Reference Name 2 Details
Designation Designation
Organization and Address Organization and Address
Phone 1 Phone 2
Mobile 1 Mobile 2
E-mail 1 E-mail 2
Use Separate sheets wherever necessary
Page 3 of 4
CHECK LIST
Sr. No. Description Page No.
1. Valid ID Proof
2. Proof of Date of Birth
3. Proof of Essential Qualification
4. Caste Certificate
5. PwBD/PwD,
6. Experience Certificate
7. NOC from present employer
8. Others (if any)
DECLARATION
I hereby declare that the information furnished by me in the Application Form is correct and nothing has
been concealed. I stating that i have no criminal case pending for investigation or trial in any police station
or court. In case any information furnished by me is found to be false/incorrect/untrue than i shall be liable
to prosecution and my claim to appointment/ service in the Institute may be cancelled/terminated at any
stage. I have also read the advertisement & other information published in this regard and understand that
my candidature is always provisional subject to verification.
Date:
Place:
Signature
Use Separate sheets wherever necessary
Page 4 of 4