Online Application Form for Coal India Limited

1. Registration Details : 2. Details of Job Applied :

A. Registration No : 0032481 A. Post Code : MT_01/2012

B. Advertisement Code : CIL_ADVT_MT01/2012 B. Discipline Applied For : 02 Mechanical

3. Personal Details : A. Name : ANIL KUMAR PATEL B. Date of Birth : January 2, 1986 C. Gender : Male D. Maritial Status : Unmarried E. Father's/Husband's Name : RAMLAL PATEL F. Religion : 70 - Hinduism G. Caste : OBC(Non-Creamy Layer) H. Physically Challenged / Handicapped : Yes Category of Disability : HH 4. Communication / Correspondence Details : A. Communication Address : VILL- MUGARDEEH; PO-POST-MUNGRA BADSHAHPUR; Town/CityDIST- JAUNPUR; State-Uttar Pradesh; Pin/Zip : 222202 B. Contact Number : 9528744734 C. Primary Email : anilcaet2008@gmail.com 5. Additional Information : A. Ex-Servicemen Category : No B. Domicile of J & K during 1/1/1980 to 31/12/1989 : No 6. Payment Details : A. Bank Challan Journal No. : NA B. Branch Code : NA 7. Other Details : A. Choice of Test Center : 58 - Lucknow (UP) 8. Education Details :
Level of Degree/Exa Specializatio Institute qualification mination n (Major) Graduate B.TECH MECHANIC BABA AL SAHEB DR. BHIM RAO AMBEDAKA R C.A.E.T ETAWAH. NA NA NA NA University/B C/P oard CSA AGRI. Pursuing UNIVERSIT Y KANPUR Duration of Date/Tentati Overall % Course(y&m ve date of ) Passing (MM/YYYY) 4Y-0M July, 2012 63.00

NA NA

NA NA

NA NA

NA NA

NA NA

NA NA

NA NA

9. Declaration : I, ANIL KUMAR PATEL, hereby declare that the information provided above is correct to the best of my knowledge and belief. If any of the information furnished above is found to be incorrect at any stage, my candidature for the post is liable to be cancelled. If at any stage of the selection process, any discripancies are found between the online data filled by me and the application sheet submitted, my application may be summarily rejected.

Signature of Candidate ____________________ Date: _________ Place: _________ Enclosures(tick relevant) [ ] Company copy of the Bank Challan (if applicable) [ ] Qualifying Examination Pass Certificate (Provisional or Degree) [ ] Caste / Disability Certificate by competent authority (for SC/ST/PH/OBC(non-creamy layer) candidates) PLEASE NOTE: a. Please paste your recent passport size photo securely in the space provided and self attest it. CIL/Subsidiary employees can get the photo attested by controlling officer and they should also get the form countersigned and stamped (with official seal) by their controlling officer before sending the same. b. Candidates appearing in final year of the qualifying examination need to have their results ready before the date of interview. c. The candidates must have CGPA of 6 and above in 10 point scale, or 60% and above, in the eligible examination. d. Applicants need to deposit money and obtain "Challan No" from the bank, which need to be entered while applying for the online application form. e. Applications without proper photo and signature will be summarily rejected. f. Please refer to the advertisement for the choice of Test Centre. The Test Centre once selected will not be changed. g. Address for Communication should remain valid for 1 year from the date of application. h. After completing the above procedures, send the application sheet to the address mentioned in the advertisement by ordinary post so that it reaches before the last date as indicated in the advertisement. i. NA stands for Not Applicable.