An ISO 9001:2008 Certified Company

Regd. & Head Office : 15N, Nellie Sengupta Sarani, 7th Floor, Kolkata – 700 087

Corporate Identification No.:U17232WB1971GOI027958 PHOTO

APPLICATION FORMAT

Sub : Application for the post of ________________________ 1.

Name in full (in Block letters)

:

2.

Father’s / Husband’s Name

:

3.

Date of Birth

:

4.

Age as on 01/04/2016

:

5.

Religion

:

6.

Nationality

:

7.

Nature of Handicap (OH/VH/HH) (Handicapped Certificate from Competent Authority to be enclosed with application)

:

8. Educational Qualification (starting from Madhyamik/ICSE/CBSE) : Examination Passed

Board/University/ Institute

Subject

Year of passing

Division / Class

Contd…..p/2

:: 2 :: 9. Experience (Present onward) : Name & Address of the Organisation

Position held

Period of Service From To

8.

Permanent Address

:

9.

Address for communication

:

10.

Phone Number with STD Code :

:

Pay Scale

Gross Pay

Pl. mention ‘PQ’ if experience is PostQualification

Residence

11.

Mobile No. E-mail address, if any

:

12.

Computer knowledge

:

13.

Whether any punishment was awarded to the applicant during the last 10 years.

:

14.

Whether any action or inquiry is held or going on.

:

I hereby solemnly declare that the above information and particulars are true and correct to the best of my knowledge and belief.

Place : Date :

(Signature of the Candidate)