) Roll No : ______________________ PART I : PERSONAL DATA (Fill in Block Letters)

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1. 2. 3.

Name in full (Block Capitals) Father’s Name (Block Capitals) Permanent Home Address: Village/Colony/Locality Post___________________

: ___________________________[Do not use initial] : ___________________________

Tehsil/Taluka________________________ Dist Pin ____________________

State__________________ Tele No with STD code 4. Present Address:Village/Colony/Locality_____________________________ Post________________________ Dist___________________ State Tehsil/Taluka___________________ Pin___________________ Tele No with STD code

E-mail Address ___________________________________ Mob No ___________________ 5. Caste/Tribe Religion Nationality ___________________ ____________________ ______________________

Mother Tongue ______________________

Marital status Married/Unmarried (If married. Any outstanding achievements (Sports/Education) (a)__________________________ (b) _________________________ (c) 9. Date of birth ____/____/__________ (Attach CTC/Xerox copy duly attested of Matriculation certificate) 7. attach an affidavit from Magistrate Stating that you have single spouse only) 8.6. Son of Serving/Ex-serviceman/Son of War Widow: Yes / No NCC Certificate: ‘A’/’B’/’C’ (If ‘Yes’ a ttach CTC copy of certificate) Previous/Current employment (If any) Yes/No (If ‘Yes’ attach CTC copy of ‘No Objection Certificate’ from employer) Name of the Employer (full address with telephone No) Sr No Designation Duration Remarks 1 2 . 10. 11 .

Speak Remarks . Language: - Sr No 1 2 3 Language English Hindi Gujarati Examination Passed Proficiency Read.PART II : ELIGIBILITY 12. Write. Education Qualification: Institute where studied Board / University Division Scored (with percentage) Sr No 1 2 3 4 Exam Subject Year 13.

15. I certify that: (a) The above information is true to the best of my knowledge and belief. (g) Relationship Certificate (Son of Serving/Ex-serviceman/Son of War Widow/Son of Widow) (Attach CTC of proof duly authenticated by the concerned Records Office) Dated: / / (Signature of the Candidate) Place: _________________ . (c) I will not claim any compensation for any injury/ disability sustained by me during screening and selection process. (b) I am fully aware that recruitment is a FREE service and no money is required to be paid to any agency. (e) Photocopies of detailed marks sheet separately for each year of G raduation:(i) First year (ii) Second year (iii) Third year or Photocopies of detailed marks sheet separately for each year of Post Graduation: (i) First year (f) (h) (ii) Second year N CC Certificate. (b) High school certificate. Domicile certificate. (d) Graduation certificates. (c) Intermediate (10+2) certificate. If at any stage.PART III: DECLARATION 14. I am liable to be disqualified/ discharged from service. I am liable to be disqualified if any information given above is found to be incorrect/incomplete/false. I declare that I am submitting the attested photocopy of the following certificates: (a) Character / Conduct certificate. it is discovered that I have paid any money to get recruited.

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