Application form

Passport size
photo

Post Applied for: _____________________
Department: ______________________
(1) Name

: ________________________________________________________________
(Surname)

(2) Address

(First name)

(Last name)

: ________________________________________________________________
__________________________________ Pin Code: ______________________

(3) Telephone No. (

) _____________________Mobile: ________________________

(4) Date of Birth: ______________________
(5) Height (cm): ___________________________ Weight (kg): __________________________
(6) E-mail: __________________________________
(7) Academic Qualifications:
Examination

Sub./
Branch

Month/
Year

College/University
/ Institute

Year of
Joining

Year of
Leaving

Percentage/
CPI

Class

Months

Remarks

10th Std.
12th Std
ITI
Diploma
Other

(8) Experience: Academic Experience Yrs ___________ Months ___________
Industrial Experience Yrs ___________ Months ___________
Sr.
No.

Institute/Industry

Position

Duration
From
To

Years

(10) Achievements: _____________________________________________________________
__________________________________________________________________________

. bring one set of photo-state copies of all certificates along with originals for submission and verification. Place: ________________ Date: ________________ Signature: ______________ Note: At the time of interview.(11) Other Relevant details: Please mention clearly and in short: Attach extra a sheet if required (11) Present pay scale: _________________________ Gross salary: _____________________ Expected pay scale: ________________________ Gross salary: _____________________ (12) Joining period required (if selected): ___________________________________________ I solemnly declare that the details provided in the application are true.

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