GHAZIABAD UNIT

APPLICATION FOR POST OF ______________________________

1.

Name in full : (Mr./Ms.)

(As per SSLC Certificate)

Age as on 01.04.2015
& Date of Birth

3.

Sex : M/F

4.

Fathers Name

5.

Nationality

6.

Category-General/SC/ST/OBC :
(Enclose Certificate in Prescribed Format)

7.

Sub-Category (SM/XSM) if applicable

8.

a)Indicate if you are a person With Disability

:
If yes, indicate nature of Disability.
(Disability certificate in the prescribed format to be enclosed)

2.

Photo to be self
attested by the
candidate.

:
OH

VH

HH

b) Degree of disability as indicated in the Certificate:

9.

Religion: Hindu/Muslim/Christian/ Sikh / Neo-Buddhist/

Zoroastrian, other (Please specify)
:

10.

Qualification: (Academic/Professional)
(Indicate division &year of passing)

Educational
status from
SSLC Onwards

Institution/University Main subject

Class secured/
percentage of
marks

Year of passing

11.
Sl.
No.

Details of Experience :
Name of the
Organisation

From
(dd/mm/yy)

To
(dd/mm/yy)

Designation/
Rank

Emoluments

Nature of
responsibilities
in brief

(Enclose separate sheet if required)

12.

Address with pin Code

Permanent Address

Correspondence Address

Telephone

Telephone

a) Mobile No:

13.

Additional information if any:

(Attach additional sheets if necessary)

14.

Undertaking

b) E-mail

I affirm that the information given above is true and correct, I further declare that if any at stage
it is discovered that an attempt has been made by me to willfully conceal or mis-represent facts,
my candidature may be summarily rejected or my employment terminated.

SIGNATURE OF THE CANDIDATE

Date:
Place:
Enclosures:
a) Certificates for qualifications.
b) Certificates for work experience