ISO: 9001 & 14001

OHSAS: 18001

fyukWFkZ bZLVuZ bysfDVd ikoj dkWikZsjs'ku fyNorth Eastern Electric Power Corporation
( Hkkjr ljdkj dk m|e )
(A Government of India Enterprise) Brook land Compound, Shillong, Meghalaya-793003
,

Advertisement No: NEEPCO/Rectt.01/ 2012 Date of receipt of application (for official use only) 1 Post Applied for 2 3 Post Code FULL NAME IN BLOCK LETTERS (Shri/Smt/Kum) First Name Middle Name

PASTE YOUR RECENT PASSPORT SIZE COLOURED PHOTOGRAPH & SIGN ACROSS

Surname

4 5 6 7 8

Fathers Name Date of Birth Age as on 01.06.2012 Birth Place & Nationality Category {Whether SC/ST/OBC (Non Creamy Layer only) /General} ** Are you a person with disability? (Yes/No) ** If yes percentage of disability (%) Choice of Written Test Centre ( Guwahati or Shillong) Permanent Address Address Correspondence Contact Information for

Date Year

Month Month

Year Days

9 10 11

12 13 14

STD Code

Telephone No.

Mobile No.

Email ID

15

Gender (Male/Female)

-1-

ISO: 9001 & 14001

OHSAS: 18001

16 17

Marital Status (Married/ Unmarried) PARTICULARS OF NONREFUNDABLE FEES

Demand Draft No._____________________________ Dated__________ Amount `___________________ Name of Bank & Branch ________________________

18 Details of Academic & Professional Qualifications ** Name of Duration Name of the Subject Examination Passed of University / (Matriculation Course Institution Onwards) Studied

Year of Passing

%age of Marks obtained

19 PARTICULARS OF POST-QUALIFICATION EXPERIENCE (as on 01.06.2012) ** Name & Post held Period of Length Nature of Reason service Address of of duties for Employer ( Give service performed leaving (attach Dates) Yrs. & service documents) From to Months.

Pay Scale (IDA/CDA) and Last drawn annual gross salary /CTC

20 21

Total post qualification experience ( as on 01.06.2012) ANY OTHER ADDITIONAL INFORMATION: (Extra circular activities, including awards, achievements etc.)

DECLARATION: I hereby declare that the particulars stated in the application form are true, correct and complete to the best of my knowledge and belief and nothing has been concealed. In case any of the information is found to be false, incorrect and misleading at any stage, I shall have no claim against cancellation of my candidature and/or taking other legal action as deemed fit by NEEPCO. Place : (SIGNATURE OF APPLICANT) Name of Applicant

Date::

** Copies of Qualification/Caste/PwD/ Experience Certificates & Marksheets to be enclosed. The rows in these section may be expanded, if required.

-2-