Online Application Form for Selection / Promotion from Non-Executive to Executive Cadre

Registration No. : CIL031200157

Applicant Details:

Name of the Company :

EIS/NEIS/PIS/Unique Man No:
Initial Date of Appointment :
Present Grade :

SAMEER RANJAN
CHAKRABORTY
NCL
26110692
16/06/1984
B

Date of Entry in Present Grade :

06/04/2010

Name of Applicant :

Affix your uploaded

passport size
photograph duly
attested by
Personnel
Executive

Personnel &
Administration

Discipline Applied for :

Experience Summary (Last three Grade/Category including the present Grade/Category) :

Grade/Category
B
C
Cat VI

From

To

06/04/2010
11/06/1999
19/03/1993

06/11/2015
06/04/2010
11/06/1999

Personal Information:
E-mail id. :
srchakraborty452@gmail.com
Religion :
Hinduism
Date of Birth : 25/06/1959 (Thursday, June 25, 1959)
Mailing Address:

Mobile No. :
Category :
Gender :

9451328779
GEN
Male

B-209,TEMPLE ROAD,BINA COLONY,BINA PROJECT, PIN : 231220, STATE : UTTAR PRADESH

Educational Qualifications :

Qualification
Post-Graduation

Name of Board / University

a.p.S UNIV

Year of
Passing
1988

Date of Online Application: 06/11/2015

Date of Hardcopy Submission at Place of Posting:
Other Terms & Conditions:
1. If shortlisted for written test & interview, I will attend the same without any conditions.
2. My application may be rejected if I am not meeting any of the eligibility norms/criteria as per the notification.
3. I understand that this selection process is being undertaken by Coal India Ltd. - Kolkata and any dispute arising out of the
same will be subject to the jurisdictions of Honble Courts of Calcutta only.

Declaration / Undertaking:
I, SAMEER RANJAN CHAKRABORTY hereby declare that the information as furnished above is correct to the best of
my knowledge and belief. If any of the information as furnished above is found to be incorrect, my candidature for the post applied
is liable to be cancelled.

Date:
Signature of the candidate
Signature of the candidate
Forwarded:
(To be forwarded by Controlling Officer)
Name:
Designation:
Company:
Place:
Certification from the Personnel Executive of the Establishment(Unit/Area)
This is to certify that I have verified the above particulars submitted by the employee with the available documents and personnel
file of the employee and found these in order and accepted the same.

Counter Signed
APM/HOD

Signature:
Name:
Designation
Office Stamp