Annexure - 1 Application for Recruitment in Pay Band-I of Rs. 5200- 20200 + Grade Pay Rs.1800 in East Central Railway ( Apply In A 4 size paper)

For office use only :-

Railway Recruitment Cell / East Central Railway

Control Number :Roll Number :-

Employment Notice No:- RRC/ECR/GP 1800/1/ 2012

1

Name of Candidate :( In Capital Letters)

2

Father's/Husband name :( In Capital Letters)

Paste (do not pin or staple) here your recent colour passport size photo of size 4cm x 5cm. (The photograph shall not be more than 1 months old.)

Signature of Candidate

3

Date of Birth : (DD/MM/YYYY)

5

Are you Physically Disabled (Please Tick (√ ) :-

4 D

D

M

VH

M

Y

HH

Y

Y

Community:- (Please Tick (√ )

Y

OH

UR

OBC

SC

ST

If Scribe required

6

Yes No (for VH/Cerebral Palsy (Please Tick (√ )

Address for communication (In Capital Letters:-) Name:-

8

Nationality

9

Religion

Address :-

7

4 Cm

10

Sex

Male

11

State

12

Nearest Railway Station

Female

Pin Code 8cm 13

Visible Marks of Identification :-

(i)

(moles/cut mark/wound mark etc on your body)

(ii)

Do you seek age relaxation under any of the category mentioned below ? ( Tick (√ ) in appropriate Box )

14 SC

OBC

ST

Physically disabled

J&K Domicile Candidate

Course completed Act Apprentice

Judicially separated / divorced woman/widow

Serving Railway Employee

15 List of Document enclosed :- (Fill in the details of the self attested copies of certificates/documents enclosed.) (i)

(iii)

(v)

(ii)

(Iv)

(vi)

16

Education Qualification Tick (√ ) the appropriate column Non Technical SSLC/ Matric

HSC/SSC

ITI

Diploma

Eligible for Fee Exemption ( Please Tick (√ )

18

Graduate

Post Graduate

Yes

Technical Graduate

Post Graduate

17

Details of IPO enclosed with the applications Name of the Post Office

Serial Number

Date

No

19 Declaration by the candidate : (Copy the passage in the box below in your own hand writing ):I hereby declare that all the particulars given above by me are true and correct to the best of my knowledge . I am aware that in the event of any information furnished by me is found false / incorrect at any stage,my candidature will be rejected summarily and I am also liable for cirminal action. I will abide by the instructions given in the notification.

Place:-

Date:-

Left Thumb impression

Signature of the applicant

Amount