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Application Form CGLE
Application Form CGLE
) Jx BE A x BE {x BE |M BE *
Please read instructions in the Notice of the Examination/Annexure-II carefully. Use Blue or Black ball pen to write in the box ( (
{F BExp BE x / Name of the Examination Centre
1.
Candidates Full Name (in English). Write in Capital Letters exactly as in Matriculation Certificate. Leave a box blank between any two parts of the name.
4.
6.
Vx BE iJ / Date of Birth
nx / Day
cx /Month
7. M / Gender
(J 1-j AB 2-{)
(Write 1-Female & 2- Male)
B /Year
10.1 BD +{ i{B xBE c ?
10. gh / Category
(J 9-+x,1 +V,2 +VV AB
6-+{B)
(Write 9-General, 1-SC, 2-ST,
6-OBC)
11.1 n c, BEb
10.2 o
? If, ExS,
whether seeking reservation?
Whether Ex-serviceman
(J 3-i{B xBE)
(Write 3- Ex-Serviceman)
28
10
Whether PH ?
(J 1-c AB 2-xc)
(Wrire 1-Yes, 2-No)
nx/Day cx/Month
12.2 ((01.01.2014)
BE +
Age as on (01.01.2014)
[B /Year]
B {i il/Date of Discharge
9. BE / Fee
(J 1-BE BE Mix n 2- U] BE nB BE)
(Write 1-Fee paid & 2- Exemption
claimed)
11. BD +{ BE BBEM c
(J 1-c AB 2-xc)
12. BD + U] Sci c?
+BEi BE
If yes, indicate code
8. ]i /Nationality
(J 1-i AB 2-+x)
(Write 1-Indian & 2 - Others)
B / Years
cx / Months
nx / Days
14. BD +{ +{JBE c?
11
12
13
14
15
16 17
18
19
20 21
22 23
24 25
26
27
29
(J 8- c )
Whether belong to Minority
Communities
as per Govt. Orders? (Write 8, if yes.
Otherwise leave it blank)
B BEb
Subject Code
{nx
Designation
BE BE BBh
Nature of the Duty(ies)
BE BE +Sv /
/From
19. {E]O{E
4 x 5 +BE BE
c c JS M {E]O{E
c ~BE fM S{BE *
(]{ x BE * {E] BE
i{i x BEBA)
Photograph
Paste here firmly your recent
photograph
(4 c.m.X 5c.m)
(Do not staple. Do not get the
Photograph attested)
Period of Service
iBE / To
________________________________________________________
{x PIN:
< x./ Mobile No. : .........................................................
20.=nB BE ciF (BEB P] ci{ )
Email ID:.
Page 1 of
2
21. Ph /Declaration
lx/Place: ..
D
iJ/Date:
* n M x c i c <x BE] n *
* Strike off this sentence if not applicable
+ciFi +Bnx {j BE q BE n VM
Unsigned application will be rejected
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