APPLICATION FROM FOR THE POST OF............................

IN 65COY ASC (SUP) TYPE D FORT SAINT GEORGE, CHENNAI-09

(USE ONLY BLUE OR BLACK BALL PNE TO WRITE IN THE BOX)
Advertisement No..Date ..Published in
To,
The Commandant,
Affix recent
65 Coy ASC (Sup) Type D
Passport size
Fort Saint George, Chennai-09
Photographs
1. Post applied for
:
duly
2. Name of the candidate in English
:
Attested by
(as written in SSC/X certificate)
Gazette
officer
3. Fathers name in English
:
4. Mothers name in English
:
5. Date of birth (in Christian Era),
:
(attach date of birth certificate duly attested)
6. Age as on last date prescribed for recent of application
Years..monthsdays
7. Gender (Male/Female)
:
8. Marital status (Married/Unmarried)
:
Address for correspondence
:
House No street/Village.Post OfficeDistt..State..PIN
Code..
9. Permanent Address
House No street/Village.Post OfficeDistt..State..PIN
Code..
10.
Tele Contact No
Landline.Mob.
11.
Case : Gen/ OBC/SC/ST(Attach
certificate in case of SC/ST/OBC)
12.
Category for which applied :
13.
Whether names registration with the Employment Exchange
and if famish the details:
a) Registration no
:
b) Name of the employment Ex-change /State
:
c) Valid up to
:
14.
Whether seeking age relaxation?
:Yes/No
15.
Age as on (If Yes on Para 14
:
16.
Whether belonging to minority communities? , Yes/No(If Yes
please specify)
17.
Educational Qualification
:
(Attach education certificate duly attested)
18.
Any other qualification/Experience
:
(Attach copy of experience certificate duly attested)
19.
Technical Training/Experience
:
20.
Domicile (Attach copy duly attested)
:
DECLARATION
I, hereby certify that above particulars mentions in the
application are correct and true

To the best of my knowledge and belief.

:
also certify that is no
comical record against me
And I am not married to more than one living person /spouse If
particulars mentioned by me are found
False at any stage, then my candidature shall be liable to be terminated
without any notice,
Place:
Date:
(signature of the
candidate)
Left thumb impression of male candidate / Right thumb impression in case of
female
Note: The covering letter/ envelope should be marked with APPLICATION
FOR THE POST OF
FOR OFFICIAL RECORD ONLY
1. Received on :
2. Accepted /Rejected :
3. Reason for rejection:
Underage/Overage/incomplete documents/ Any other reason to be
specified
4. Index No Date of test ..
ACKNOWLEDGEMENT CARD CUMCALL LETTER
Post :.(post for which applied )
Affix recent
1. Name
:
Passport size
2. Fathers name
:
Photographs
3. Address for correspondence
duly
(to be filled same as per column 9 of application form):
Attested by
House No/ Street /Village : .
Gazette officer
Post office : ..Distt:
(one spare)
State :.Pin Code:
..
4. Index No date and time of physical test&written
test
5. Venue of physical & written test
.
(Signature of the Candidate
Officer)
Note : The individuals should be in possession of acknowledgement card
sent by this Office and all
Original documents for verification at the time of call ,
individual who
are not in possession of
Acknowledgement Card will not be entertained.

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