Gujarat State Child Protection Society

C Wing, Ground Floor, Birsa Munda Bhavan, Sector 10/A, Gandhinagar

APPLICATION FORM
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Name of Post applied for: _______________________________________________________________

Name
Address

:
:

_____________________

_____________________

__________________

(Surname)

(First Name)

(Middle Name)

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

Contact No.

(R) ___________________ (M) ____________________ (O) __________________

Email Address:

___________________________________________________________________

Gender

___________________________

Nationality

___________________________

Date of Birth :

Marital Status: _______________________

___________________________ (dd/mm/yyyy) format

Educational Qualification:
Qualification
1. Graduation
2. Post Graduation
3.

1) Job Experience:

Degree

Name of University

Year

Percentage

Total Experience: (Years) ____________________

1. Name of Organization
2. Designation
3. Period
4. Work Profile
5. Remuneration (#)
2) Job Experience:
1. Name of Organization
2. Designation
3. Period
4. Work Profile
5. Remuneration (#)
3) Job Experience:
1. Name of Organization
2. Designation
3. Period
4. Work Profile
5. Remuneration (#)
# Original Mark sheets and Last pay slip will have to be produced at the time of interview.

Key Expertise:
__________________________________________________________________________________________
__________________________________________________________________________________________
Training / Workshop Details:
1). _______________________________________________________________________________________
2). _______________________________________________________________________________________
Publications / Paper Presented:
__________________________________________________________________________________________
__________________________________________________________________________________________
I, the undersigned, certify that to the best of my knowledge and belief, this application correctly describes
my self, my qualification and my experience.
Date: ____________________
________________________
Signature