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APPLICATION FOR THE POST OF THE DEPUTY ENGINEER IN MECHANICAL / ELECTRONICS &
COMMUNICATION ON FIXED TERM BASIS FOR A PERIOD 03 YEARS.
1]

/Instructions :
a]
b]

2]

All columns should be filled in Block Letters.

Incomplete applications / applications without enclosures will be rejected.

/ Post Code

: ________________________________________

/Post applied for : ( )

a]

/Deputy Engineer

/ Mechanical

b]

/Deputy Engineer

../ECE

3]
4]

5]
6]

/Full Name (In capital letters)

: .............................

Fathers Name & Occupation

: .............................

/Date of Birth

: ................/Age........

/Sex

7]

/Marital Status

8]

/Category (Tick Mark)

/Male

/Female

/Married
GEN

SC

/Unmarried
ST

OBC

(In case of SC/ST/OBC Name of the Community and sub-caste ...(Enclose copy of valid certificate)
9]

/Whether Physically Challenged

/Yes

10]

,
If yes, indicate type of Disabilities?

OH

9]

/Permanent Address

/No

VH

HH

: ...............
...............
................

10]

/Correspondence Address

: .......................
........................
........................

11]

/State of Domicile

: ................

/Nationality..

12]

/Telephone No.

:( R ) ............. (O)...............

13]

/Mobile No.

: ......................

14]

- . /E-Mail ID(mandatory)

: ......................

:2:
/EDUCATIONAL QUALIFICATIONS (starting from Matriculation):

15]

/Education

Year Studied

/Name of the
Institution

/From

/To

/
Class/
Divn.

Branch /
Discipline

/SSLC
/Matriculation

Grade / % of
Marks

/12 Std
th

/Degree
/Others .
(please specify)
16]

/EXPERIENCE :
(Start with the current employment)

/Name of the
employer and address

/Duration

Designation

/From

/To

, /

/Brief note
on duties & responsibilities
/ projects handled

Total
years of
Exp.

(Attach separate sheets if required)

17]
/ Salary Last Drawn
/Gross Pay
18]

/Languages Known

: ( /Underline Mother Tongue)

/Read

19]

..

/Write

/Speak

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Details of Application Fee:

DD No Amount Rs..
Name of Bank and Branch
/DECLARATION

/ /

/ /

I hereby declare that the above statements are true and complete to the best of my knowledge and belief. In the event, if
the information is found to be false or incorrect, my candidature / appointment may be terminated without notice.

/Place :

/Date :

/Signature of candidate