APPLICATION FOR THE POST OF : SENIOR ASSISTANT [ELECTRONICS]

Affix Recent self attested Passport Size Photograph

STATE OF DOMICILE NAME FATHERS NAME DATE OF BIRTH [DD/MM/YYYY] EDUCATIONAL / TECHNICAL QUALIFICATION SL.NO NAME OF THE COURSE

MARKS OBTAINED

PERCENTAGE

EXPERIENCE

..YEARSMONTHS

NAME OF ORGANIZATION

Whether currently employed in Govt./PSE/Autonomous Body PRESENT ADDRESS[with Pincode] [email ID & Phone No., if any]

YES / No

PERMANENT ADDRESS [with Pincode] Community [Please Tick] WHETHER BELONGS TO Ex-Serviceman DEMAND NUMBER & DATE BANK BRANCH GEN YES No.: BANK: OBC SC NO Date BRANCH ST

[a] CHENNAI CHOICE OF CENTRE [Please tick any one] [b] HYDERABAD [c] TRIVANDRUM [d] BANGALORE Llll

I hereby declare that the above information is true and correct to the best of my knowledge. Date: Place: SIGNATURE OF APPLICANT