APPLICATION FORMAT
1. Post Applied for (in Block Letters) : _________________________ Level___________
2. Name in full (In Block letters) : ____________________
3. Fathers Name : _________________________________
Passport size
photograph
4. Date of Birth : _________________________________
5. Community : _________________________________
( SC/ ST/OBC/PH/ Un-Reserved ). Please attach certificate)
6. Religion : ______________ Whether belong to Minority: Yes/No (Please tick)
7. Correspondence Address : _______________________________________________________
(In Block letters)
_______________________________________________________
_______________________________________________________
8. Contact No; Mobile : ______________________________________________________
Telephone : (O)______________________ (R) _________________________
Fax : _________________________ E-mail______________________
9. Qualifications (Academic & Professional) : (Please attach proof)
Exam passed Year of passing Name of the Max marks Marks obtained % of marks
Inst/University
10. Name of the Present Organization : _________________________________
Please mark ( ) in appropriate box below
Govt (Central/State) PSU Autonomous bodies Others
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11. Experience Details (Post qualification only)
Name & address Post held Nature of experience (attach separate sheet
of employer From To Pay scale & if required)
gross
emoluments
12. Total post qualification work experience :_____years _____months (Please attach proof)
13. Details of Computer proficiency _________________________________________
14. Have you applied earlier in HSCC during last two years : Yes/No
If yes,
a. Post applied for
b. Month & Year
c. whether attended interview Yes/No
15. Have you worked earlier with HSCC : Yes/No
If yes, please specify, period From________ to__________
Last post held :______________
16. Do you have any relative working with HSCC : : Yes/No
If yes, please specify, Name & Designation :
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17. Do you know anyone in HSCC under whom
you have worked earlier in any organization : Yes/No
If yes, Name of the HSCC employee under whom
you have worked :
Name of the organization
18. Achievement, if any : ________________________________________________________
:
19. Other relevant information, if any :________________________________________________________
20. List of Enclosures (Please mark ()
i. 10th certificate
ii. 12th certificate
iii. Degree certificate + mark sheet
iv. Professional qualification certificate(s) + mark sheet
v. Proof of experience
vi. Salary certificate
viii. Caste certificate
ix. Any other______________
Verification
I declare that the information furnished above by me is true to the best of my knowledge and belief and that nothing material
has been concealed.
_____________________
Signature of the Candidate
Place :
Date :