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For office use only 1- Application No. EDM...................................... 2- Date of receipt:................................................... 3- DD attached? Yes/No. 4- Application Accepted/Rejected5- Reason (if rejected)-----------------

vkosnu i= dk izk:i
APPLICATION FORM FOR THE POST OF e-DISTRICT MANAGER HARDOI First Name * Father/Husbands Name* Address for Communication* Permanent Address * Note:- FILL IN ONLY CAPITAL LETTERS (Use only blue ball pen) A4 size paper Surname* Gender*

Address 1* Address 2 Pincode * Address 1* Address 2 Pincode *

State * District * State * District * Age ( As on 1st April, 2013) Contact No (Landline) Photo Self Attested

Date of Birth* (DD/MM/YYYY Email ID* Contact No (Mobile)* Qualification * S.No.

Qualification

Name of Institution/University

Year of Passing

Marks in %/CGPA

Type (Full time/part time/distance)

1 2 3 4 Languages Known

Post Graduation Graduation 12th 10th Read Hindi English Other Write Speak

Work Experience Name of Employer 1 2 3 Photo ID Proof*

# # # Attested copies of all document (By Gazetted Officer) should be attached with the form. The original copies of educational qualifications, experience certificate, Address proof and photo ID proof should be carried along at the time of interview. Preference will be given to those applicants who reside in Hardoi.

From Date (Month/Year)

To Date (Month/Year)

Designation

Total Experience (In Months)

I hereby declare that all the statements made in my application and the attached job application form are true, complete and correct to the best of my knowledge and belief. In the event of any information being found false or incorrect at any stage, my application is liable to be rejected and if already appointed, my services are liable to be terminated without notice.

Dated:Signature

Applicant