ISO: 9001 & 14001

OHSAS: 18001

fyukWFkZ bZLVuZ bysfDVªd ikoj dkWikZsjs'ku fyNorth Eastern Electric Power Corporation
( Hkkjr ljdkj dk m|e )
(A Government of India Enterprise) Brook land Compound, Shillong, Meghalaya-793003
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Advertisement No: NEEPCO/Rectt.01/ 2012 Date of receipt of application (for official use only) 1 Post Applied for 2 3 Post Code FULL NAME IN BLOCK LETTERS (Shri/Smt/Kum) First Name Middle Name

PASTE YOUR RECENT PASSPORT SIZE COLOURED PHOTOGRAPH & SIGN ACROSS

Surname

4 5 6 7 8

Father’s Name Date of Birth Age as on 01.06.2012 Birth Place & Nationality Category {Whether SC/ST/OBC (Non Creamy Layer only) /General} ** Are you a person with disability? (Yes/No) ** If yes percentage of disability (%) Choice of Written Test Centre ( Guwahati or Shillong) Permanent Address Address Correspondence Contact Information for

Date Year

Month Month

Year Days

9 10 11

12 13 14

STD Code

Telephone No.

Mobile No.

Email ID

15

Gender (Male/Female)

-1-

) DECLARATION: I hereby declare that the particulars stated in the application form are true. & service documents) From to Months.ISO: 9001 & 14001 OHSAS: 18001 16 17 Marital Status (Married/ Unmarried) PARTICULARS OF NONREFUNDABLE FEES Demand Draft No. achievements etc. Pay Scale (IDA/CDA) and Last drawn annual gross salary /CTC 20 21 Total post qualification experience ( as on 01. The rows in these section may be expanded. correct and complete to the best of my knowledge and belief and nothing has been concealed.06.2012) ** Name & Post held Period of Length Nature of Reason service Address of of duties for Employer ( Give service performed leaving (attach Dates) Yrs.06. -2- ._____________________________ Dated__________ Amount `___________________ Name of Bank & Branch ________________________ 18 Details of Academic & Professional Qualifications ** Name of Duration Name of the Subject Examination Passed of University / (Matriculation Course Institution Onwards) Studied Year of Passing %age of Marks obtained 19 PARTICULARS OF POST-QUALIFICATION EXPERIENCE (as on 01. I shall have no claim against cancellation of my candidature and/or taking other legal action as deemed fit by NEEPCO. including awards.2012) ANY OTHER ADDITIONAL INFORMATION: (Extra circular activities. Place : (SIGNATURE OF APPLICANT) Name of Applicant Date:: ** Copies of Qualification/Caste/PwD/ Experience Certificates & Marksheets to be enclosed. if required. incorrect and misleading at any stage. In case any of the information is found to be false.