APPLICATION FORM

1. Post applied for 2. Name of the Employment Exchange

: :

(if available) and (i) Registration No. (ii) NCO No. 3. Full Name (IN BLOCK LETTERS) : 4. Father’s Name : : 5. Mother’s Name 6. Date of Birth (as in matriculation Certificate) : 7. Address (in full) : (i) Correspondence (ii) Permanent 8. Whether SC/ST/OBC : 9. Whether Ex-Servicemen : 10. Whether Physically Handicapped : (if so percentage & details of disability) 11. Whether Govt. Servant, if yes details : (Govt. servant are required to apply through proper channel) 12. Details of Examination passed: Sl. Examination University/Board Year of Name/Address of Institution No. Passing attended

Percentage of marks

1. Experience: Sl. No.

Name of the employer

Designation of post

Pay scale

Nature of duties

Period of employment

Last pay drawn

Reason for leaving

2. Any Additional information I solemnly declare that the statement made by me in this application form is correct to the best of my knowledge & belief. I undertake that if any information given by me is found false at any time, it will render me ineligible for the applied above and legal action will be initiated against me. I fulfil all conditions of eligibility regarding age-limit, educational qualification etc. for this post. Signature of the candidate Dated ……… Place ……....