APPLICATION FOR THE POST OF___________________________________Affix your

recent
passport size
photograph
01.

Name of Applicant

02.

Father's / Husband's Name

03.

Date of Birth (DD/ MM / YYYY)

04.

Age as on 18.12.2014 ( supporting

Documents to be enclosed )

Years

05.
06.

Gender
Category (SC/ ST/ OBC / UR)
(Proof to be submitted)
Whether Physically handicapped (Yes/
No) If yes, nature of disability and its
degree (supporting documents to be
attached)
Mailing Address
(With Pin Code)

Male

07.

08

09.

Permanent address (With pin code)

10.
11.

Demand Draft Details

Educational Qualifications (starting
from SSC / SSE (10th onwards)
S. No
Academic
Name of
Qualification
Board /
University

12.

13.

List of documents attached

i) Proof of age
iii) Caste certificate, if applicable
Experience: (Attach proof)
Organization

Month

Days

Female

:
:
:
Year of
Passing

Subject(s)

% age of
marks
obtained

:
ii) Proof of educational qualification
iv) Disability certificate if applicable
:
Post held
Period
Present
pay scale

Class /
Division

Nature of
duties

Declaration:
Certified that the information furnished above is true and correct to the bests of my knowledge
and belief and in case the same is found false or incorrect at any stage, my candidature /
appointment may be cancelled / terminated.
Date..
Place..

Signature