Employment Notification No.05/2010 Dated 1 2. Father's / Husband's Name 3. 4. oT Sy URL Ng RAILWAY RECRUITMENT CELL Cer re Application Form for Posts with Grade Pay % 1,800/- in Southern Railway & ICF 5.12.2010 . Name of the Candidate (ame in CAPITAL letters followed by initials) Nearest Railway Station Address for Communication Paste here a copy of your recent passport size photograph taken within ‘one month State PIN Contact Phone / Mobile Number with STD Code [ick (7) appropriate column} 5. Nationality 6. Religion 7. Sex [Male [ Female] 8. Marital Status [Married] Unmarried 9. Community [Tick (W) appropriate column] (Enclose copy of certifcate) [__UR_ | OBC | SC ST 10. Date of Birth : (Enclose copy of certificate) Date Month Year 11. Educational Qualifications : (Tick (7) appropriate column! (Enclose copy of certificate) Course completed Non-Technical Technical SSLC/ Matric] HSC/ SSC] ITI Act Apprentice Diploma | Graduate | Post Graduate]| Graduate | Post Graduate 12. 13. 14. Tick (7) appropriate column, if applicable. (Enclose copy of certificate in support of claim) Parsons with Widow / Divorced Sening | _Geniral? | StaffofQuasi | Residents of sont Disabilies Jcicaly | yEconomicaly | Raiway | state Govt] Administrative | Jammu & serviceman! Tiy_|__| On separated Employees | Employees | offices of Raiways | Kashmir Write Personal marks of Identification : 1 2 Details of IPO / DD Number Date Name of the Post Office / Bank & Place oa Te) N=) i er ST) 2Y NES (Please reproduce the paragraph in your own running handwriting) Thereby deciare that all the particulars given in this application are true and correct to the best of my knowledge and belief. In the event of any information being found false, my candidature / appointment is liable to be cancelled / terminated Place Date Left Hand Thumb Impression Signature of the Candidate (Must be clear and not smudged) (Do not sign in CAPITAL letors)