MUNICIPAL CORPORATION, CHANDIGARH

NEW DELUXE BUILDING, SECTOR-17

CHANDIGARH.
APPLICATION FORM

Post Applied for: -------------------------------

Paste
Passport Size
Self Attested
Photograph
here

For office use only

Reservation category.

Diary No.

Date of receipt

Candidate must read instructions carefully before filling this form. Tick only the relevant boxes.
1.

Name of the Candidate

2.

Father's Name

3.
Address
a) Correspondence Address

Pin Code:
b) Telephone No.

Land Line (with code)

Mobile

E-mail
c) Permanent Address

Pin Code:
4. Age
Day

Month

Year

Day

Month

Year

5. Sex

Male

Female

6. Marital Status

Married

Unmarried

a) Date of Birth
b) Age as on 1-1-2010
(Tick the relevant Box)

(Tick the relevant Box)

7. Category

8. Category for age

Relaxation( if applicable)
9. Detail of Fee
Name of Bank

Branch

Draft No.

Amount

Date

10. (i)
Sr.
No.

Details of qualifications :Examination

Passed

Board/University

Month &
Year of
Passing

Subject

Percentage
of Marks

(ii)
Do you possess any of the following qualification (Tick the relevant box)
S.No. Name of Post
Essential qualification
1.
Sub Divisional
Degree in Civil Engineering from
Yes
Engineer(B&R)
recognized University/Institute
2.
Sub Divisional
-doYes
Engineer(Building
Branch)
3.
Sub Divisional
Degree in Civil Engineering or
Yes
Engineer(Public
Mechanical Engineering from a
Health)
recognized University/Institute
4.
Sub Divisional
Degree in Engineering in Electrical
Yes
Engineer(Electrical ) from a recognized University/Institute

No
No

No

No

(iv) Details of Experience

Department/Organization

v)

vi)

Post held

From

To

Pay Scale

Are you in Government Service?

Yes______

No______

If yes, have you informed your Head of the

Office/ Department.

Yes______

No______

Have you ever been disqualified by Union Public Yes______

Service Commission or any other State Public Service
Commission?

No______

vii) Have you been convicted by any Criminal Court ?

If yes, what was the punishment given.
viii)

Yes______

No______

_____________________

Whether there is any Criminal case pending/registered Yes______

No______
against you?
If yes then what is the present status of the case.
_____________________
_____________________

(PLEASE SIGN ONLY RELEVANT DECLARATIONS)

DECLARATION
I hereby declare that all statements made in this application form are true, complete and
correct to the best of my knowledge and belief. In the event of any information being found false or
incorrect or ineligibility being detected before or after the selection, action may be taken against me
by Municipal Corporation/Chandigarh Administration, which may result in my disqualification,
cancellation of candidature and/or removal from service, if selected.
Place:
Date:

Signature of the Candidate

I hereby declare that I am employee of Chandigarh Administration/State Governments/Central

Governments and I have informed my Head of the Office/Department in writing that I am applying for
this post.
Place:
Date:

Signature of the Candidate

________________________________________________________________________________

CHECK LIST
Have you attached the following certificates duly attested by Gazetted Officer:
Yes
1.

Date of Birth Certificate of Matriculation/Higher Secondary

2.

Degree Certificate B.E CIVIL/Mechnical/Electrical

3.

Detail Marks Card of. B.E CIVIL/Mechnical/Electrical

4.

Experience Certificate from the appointing authority.

5.

Reserve Category Certificate

6.

Bank Draft

7.

Three Identical Passport size photographs

8.

Whether concerned declarations have been signed or not?

No

Signature of the candidate