APPLICATION FORMAT

(To be filled by the candidate in his/her own handwriting in capital letters with black pen)

Candidates to
affix recent
passport size
colour
Photograph

I hereby apply for the post of ___________________________

(Advertisement No. __________________________________)

Sign here (in the box)

Name of the Candidate
(As recorded in the Matric / Secondary School
Certificate)

Mothers Name
2

Fathers Name

Postal Address for Communication

(with PIN Code No.)
P

Email id

Contact No. (Tel No with STD Code/Mobile No)

Day

Date of Birth

Month

Year

6
Age as on 03.08.2015
7

Gender (Please Tick)

Category (Please Tick)

Ex. Serviceman (Please tick, if applicable)

10

State of Domicile

YEARS . MONTHS
MALE
FEMALE
SC

ST

OBC

GEN

Ex. Serviceman
11

Nationality

12

Religion

13. ALL EDUCATIONAL QUALIFICATION (MATRIC/CLASS 10th ONWARDS):

Qualification
(Academic, Technical, Professional &
Computer related, if any)

Name of Board / Institute

Duration of
Course
(in years)

Month and Year

Joining the
course

Passing the
course

% of Marks
Obtained

14. ITI Trade code for Technical Attendant-I (Please refers to website notification):
15. DETAILS OF EMPLOYMENT, IF ANY
Name & Address of Employer

Post Held

Period of Service
From
To

Salary per Month

16. DETAILS OF APPLICATION FEE, IF APPLICABLE

Demand Draft No.

Name of Issuing Bank

Date of Issue

I hereby declare that I have read all the conditions mentioned in the advertisement and I fulfill the same. The statements made in this application are true,
complete and correct to the best of my knowledge and belief. I understand that in the event of any particular or information given herein being found false or
incorrect, my candidature is liable to be cancelled and in the event of any mis-statement/discrepancy in the particulars being detected after my appointment,
my service is liable to be terminated without any notice to me.
Date: .
Place: .
Signature
Note:
1. The application must accompany the following documents (no other documents to be attached):
a. Attested copies of Matric, ITI/Diploma Semester wise Marks sheets and Diploma Certificate (wherever applicable)
b. Provisional Trade Certificate/National Trade Certificate issued by NCVT (for Technical Attendant-I post)
c. SC/OBC/Ex-SM certificate issued by Competent Authority in the prescribed format, if applicable
d. Demand Draft (if applicable)
e. Experience Certificate (if any)
2. Application received after due date would be summarily rejected.