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SOUTH EASTERN COALFIELDS LIMITED

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(A Subsidiary of Coal India Limited)
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-9
APPLICATION FORM
/For Office se Only
9
A!!lication Form No"

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#ate of Recei!t



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SOT+ (AST(RN COALFI(L#S LIMIT(#
(A Subsidiary of Coal India Limited)
Page | 2

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Page | 3

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SOT+ (AST(RN COALFI(L#S LIMIT(#
(A Subsidiary of Coal India Limited)
Page | 4

$'" 1
MARITAL STATS H
MARRI(# NMARRI(#

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(#CATIONAL ? PROF(SSIONAL 3ALIFICATION STARTIN2 FROM T+( MOST
R(C(NT*
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(Candidates s@all submit a !roof to t@e effect t@at t@e Institute/#i!loma<deAree<certificate<ot@er testimonials is recoAniBed by
t@e 2o%ernment of India")

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(a) #(TAILS OF (MPLO0M(NT STARTIN2 FROM T+( MOST R(C(NT
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NAM( OF T+(
OR2ANISATION

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SOT+ (AST(RN COALFI(L#S LIMIT(#
(A Subsidiary of Coal India Limited)
Page | 5

TOTAL EXPERIENCE (in Years)
$7" (H) 4 H H |/HH |/7 / H H
(a) =+(T+(R PR(S(NTL0 =OR-IN2 IN 2OD(RNM(NT< S(MI 2ODT" < STAT( 2ODT"/PSU
0(S | NO

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(b) =+(T+(R PR(S(NTL0 =OR-IN2 IN AN0 S,SI#IAR0 OF COAL IN#IA LIMIT(#
0(S | NO

* 14 9t C 16 (N) W1 (4) 1 N W V I RH1
*If te ans!er "f te a#"$e %&esti"n N"' 1((a) ) (#) is YES ten te a**+i,ati"n s"&+-
#e sent tr"&g *r"*er ,anne+

$8" H H :
(MPLO0M(NT (CC+AN2( R(2ISTRATION #(TAILS (If any)
H E:
R(2ISTRATION NO"

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0(AR OF R(2ISTRATION

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I1 do @ereby declare t@at all statements made in t@is a!!lication are true to t@e best of my
FnoGledAe and belief" In t@e e%ent of any !articular or information1 furnis@ed by me1 found false
or incorrect1 my candidature is liable to be reHected or cancelled and in t@e e%ent of any statement
< information found false e%en after a!!ointment1 my ser%ices are liable to be terminated Git@out
any notice"
1/PLAC(*
/#AT(*
H| 1H
SI2NATR( OF T+( CAN#I#AT(






SOT+ (AST(RN COALFI(L#S LIMIT(#
(A Subsidiary of Coal India Limited)
Page | (

H| 9 H : 4 H 1
C+(C-LIST FOR T+( CAN#I#AT(* PT A TIC- ( ) IN T+( APPLICATION ,OC
A2AINST T+( IT(M (NCLOS(#

$" H [1H 1
A!!lication duly com!leted and siAned

'" 11H 909 H H 9 9 HH| H
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Four no" self attested !ass!ort siBe colour !@otoAra!@s Git@ t@e name clearly Gritten on t@e bacF side"

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All t@e reIuired (ducational Certificate and MarFs s@eet for t@eir rele%ant disci!lines
as !er eliAibility criteria

4. HH|| 9 9H 91 HH ~O 1/H/0
/H7 9H-/ 9T, H q H7 9 1
Candidates s@all submit a !roof to t@e effect t@at t@e Institute/#i!loma<deAree<certificate<
ot@er testimonials is recoAniBed by t@e 2o%ernment of India"

5" H 9H (H /HH/HHH H| 9)
Caste Certificate (for SC < ST < O,C Candidates) enclosed (If any)

7" HH 9H 1
(J!erience Certificate enclosed

8" '5". J$$". .H. (10J 4.5 ) Os| 99 1
TGo GindoG en%elo!e of '5". C $$". cm" ($; J ."5 Inc@) enclosed