Application Form

Sr. No., Name & Exam Centre of the post for which you are Applying :
Post Name____________________________ Exam Centre ________________ Sr. No._________
Name of the Candidate: -

(as mentioned in matriculation certificate In English Capital Letters Only)

Fathers Name: -

(In English Capital Letters Only)

Mothers Name: -

(In English Capital Letters Only)

Date of Birth: -

(Attested copy of Certificate is to be attached)

D

(Dont staple the

photo)

Age (as on 01-08-2015 date): Years

Gender: -

Month

Male

Nationality: - Indian
Category: -

Days

Female
Others

(Gen/SC/ST/OBC/PH)

Correspondence Address: -

A newly passport
size photo attested
by a Gazetted
Officer is to be
pasted here.

Signature of the Candidate

(Use Black Pen Only)

Pin Code

Permanent address: -

(Use Black Pen Only)

Pin Code

Contact No. - 1. 2 ..
E-mail id: -

1. 2. .

Educational Qualification: Examination

Passed

Name of the University/Board

Year of
Passing

Subjects

Percentage
Obtained

Other Qualification:1. ..........................................

2. ..........................................
3. ..........................................
List of Documents Attached:1. 2 3 ...
4. 5 6 ...
7 .... 8 9 ...
Any Experience:1. ..........................................
2. ..........................................
3. ..........................................

Declaration:
I Mr. / Ms . hereby declares that the statement furnished by me as stated
above in my application is true and correct to the best of my knowledge. If anything is found
incorrect of false, the application is liable to be rejected and if the mistake/fraud is detected after my
selection, my service is liable to be terminated and criminal case may also be initiated.

Place___________
Date____________

Signature of the Candidate