Application Form

For Office use

Control No.
1.

Name of Post : __________________________________________

2.

Candidates Name : _________________________________________

Write in CAPITAL/BLOCK letters in (Sl. No. 2,3 & 6)

3.

Fathers Name : _____________________________________________

4.

Nationality : _________________________________

5.

Regional : ______________________________________________

6.

Address for Communication with NRS : _____________________________

_____________________________________________________________
______________________________________________________________

7.

Date of Birth
Day Month Year

10.

9. Community Mark ()

Male Female

SC ST GEN Ex-Ser PH

Educational Qualification : (Enclose proof duly attested for Sl. No. 10,11)

Sl.
No.

11.

Examination Passed

Board/University

Duration

Year of Passing

Marks %

Duration

Year of Passing

Marks %

Professional/Additional Qualification :

Sl.
No.

12.

8. Sex (Mark tick ()

Examination Passed

Board/University

Medium of examination : English/Hindi

13.

14.

If Ex-Serviceman : ___________________________
(a)

No. of year service rendered : ____________

(b)

Date of entry in armed force : __________________

(c)

Date of discharge from armed forces : _____________________

Whether employed in Govt. Service/PSU : Yes/No

If yes, a)

15.

Name of the Organization : _____________________

b)

Post Held

c)

No. of years Service rendered

Details of IPO/DD

Sl. No.

IPO/DD Issued by

IPO/DD No.

Date

Amount

Declaration
I .. do hereby declare that all the statements made in this application are true,
complete and correct to the best of my knowledge. In the event of any information being found
false/incorrect at any point of time, my candidature will stand automatically cancelled.
Left Thumb Impression :
Place : ..

Signature of the Candidate

Date :

Name : .

davp 10201/11/1490/1112

EN 29/20