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//Gad-1//D:\User-2012\Bhartidafter\ADV-12\Adv.DEE,AE(CIVIL)JNURM-13(January).doc-2


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Application Format
PRO NO._________

1. Name of Post:

Passport
size
photo

2.

Full name of Applicant: ______________________________________________

(Surname,
Name
Fathers/Husbands name)
3. 1) Address for correspondence:
(with pin code and Tel.No.) _______________________________________________
__________________________________________________________________________
2) Permanent Address: _____________________________________________________
__________________________________________________________________________
Pin code No. _________________Phone No. _________________
Mobile No. _________________
4. Caste: (General/SEBC/SC/ST)
( Reserved candidates should enclose certificates of competent authority)
5. a) Date of birth
: _____________
b)Age : _______Years ______ Months ______Days as on - -2013
6. Educational Qualification
Sr.No.

7.
Sr.
No.

Name of Exam

Board/uni./
Institute

Year of passing

Marks secured
Grade/ Class/ %

Experience: (attach certificate of experience mentioned below)

Name of Co./
Organization

Period.
From .
to

Duration
Years /
Months/
Days

Post held

Description of
duties/
Functions

Reason
for
leaving
the job

Attestation: All the information given is true and correct and I have not mentioned any wrong
information or intentionally hidden any fact. If anything proves wrong, I shall abide by the
decision/ action taken by the Vadodara Mahanagar Seva Sadan.
Place: _________

Date:_________

Signature of candidate:

_________________________

G.A.D.
P.RO. NO.
1.
839/12-13

Department

Details

2.

3.
Adv.for
D.E.E &
A.A.E.(Civil)

G.A.D.

Period for Application

Start Date End Date
4
5.
22-01-13

30-01-2013