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PROFORMA FOR APPLICATION
APPLICATION FOR THE POST OF
(2) Post applied for
Paste a Self
attested
(2) Name of Candidate (In Block letters) Photograph
(3) Father’s Name
(4) Date of Birth A ol
(attach copy of Birth Certificate self attested)
(5) Age as on the last date : Years ..
prescribed for receipt of application)
(6) Address for correspondence
House No/Street/Village
Post Office ..
State.
(7) Permanent Address
House No/Street/Village
Post Office ..
State ..
(8) Caste Gen/OBC/SC/ST
(attach self attested certificate in case of SC/ST/OBC)
(9) _ Educational Qualification
(attach education certificate self attested)
Months.
ays:
. Dist
Pin Code
. Dist
Pin Code ....
(20) Any other qualification/Experienc
(11) Category for which applied : Gen(UR)/OBC/SC/ST/EWS/Ex-
Serviceman/Meritorious Sport person/ Physically Handicapped ..
(attach self attested copy)
(22) Technical Training/Experience:
(13) Domicile
(attach self attested copy)
(14) Whether registered with any Employment Exchange: Yes/No
(If yes, mention Registration No and Name of employment exchange)
(15) Thereby certify that above particulars mentioned in the application are correctand
true to the best of my knowledge and belief, if particulars mentioned by me are
found false at any stage then I shall be liable to be terminated without any notice.
Date: Signature of candidate
FOR OFFICIAL RECORD ONLY
1. Received Of sss
2. Accepted/Rejected ...
3. Reason for rejection: Underage/Overage/incomplete/Any other reason to be
specified
4. Index No Date of Test / skill / practical / physical test.Post of ...
Acknowledgement Card
Paste a
Self
attested