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Corporation Bank

[A PremIer PubIIc Sector ankj


Corporate DffIce : |angaladevI Temple Foad, Pandeshwar, |angalore 575 001.
Tel : (0824) 2426416 2426420 Fax : (0824) 24264J1

APPLICATIDN FDPh - FDP THE PDST DF ______________________________
[To be fIlled In by the candIdate In hIs/her own handwrItIng]
Peg. No.:

I. PEPSDNAL PPDFILE:

1. Name In fuII (In Iock Ietters):




2. Name of the FatherlHusband: ...............................................


J. (a) 0ate of Irth :


(b) PIace of Irth : ............................. ...... (c) NatIve PIace (VIIIage) .............................

(d) TehsII ....................... .................. ...... (e) 0IstrIct .............................. .......... .....

(f) Contact Phone wIth ST0 Code............... (g) hobIIe No ...................

4. NatIonaIIty............................................. PeIIgIon.........................................................

5. (a) hother Tongue :........................................
To speak To read To wrIte
(b) Language known:




6. (a) Permanent Address (b) Present Address for CommunIcatIon:














P H D T D
0ate |onth Year
:2:

7. harItaI Status (SIngle/|arrIed/WIdowed/0Ivorced/Legally Separated): ..............................................

8. State the persons, If any, who are fuIIy dependent on you ...........................................................
(Parents, WIfe/Husband, ChIldren, 8rothers/SIsters, Dthers)

9. Whether you are:

(a) A member of Scheduled Caste YES/ND : f yes, Subcaste : ........................................
(b) A member of Scheduled TrIbe YES/ND : f yes, SubtrIbe : ........................................
(c) A member of Dther 8ackward Class YES/ND : f yes, Subcaste : ........................................
Sl. No. In the Central LIst : ........................................
(d) An ExservIceman/0Isabled ExServIceman YES/ND : f yes, the No. of years of servIce put In 0efence
ServIces: ............................... ................. ..............
Feasons for and date of dIscharge : ........................... ....
(e) PhysIcally HandIcapped YES/ND : f yes, nature and of dIsabIlIty : .......................
............................... ................. ...............
Note: A certIfIcate In orIgInaI from the Competent AuthorIty shouId be produced In the case of candIdates
beIongIng to ScheduIed Castes, ScheduIed TrIbes and Dther ackward CIasses. In the event of
conversIon or re-conversIon to the HIndu or SIkh reIIgIon, adequate evIdence, IncIudIng a copy of
the reIevant Cazette NotIfIcatIon and aIso other documentary evIdence shouId be furnIshed. In
other cases, suffIcIent documentary evIdence IncIudIng the medIcaI certIfIcate, wherever
necessary, shouId be produced.

II. E0UCATIDNAL PPDFILE:

10. EducatIonaI uaIIfIcatIons (FuII partIcuIars from HIgh SchooI onwards, to be gIven )

Name of the
oardlInstItutIonl
UnIversIty
PerIod
From - To
haIn subjects studIed
CIass and
rank
secured
X of
marks
secured
PrIzeslAwardsl
SchoIarshIps
and other
dIstInctIons If
any, secured
SSLC l X Std. :




IntermedIatelPUClHSClXII Std


CraduatIon :

Post CraduatIon :

AddItIonaI 0IpIomasl uaIIfIcatIons:

:J:


11. 0o you have computer knowIedge! If yes, furnIsh detaIIs

Name of the
Course
Name of the InstItute
Course
duratIon
Year Subjects Iearnt
0IpIomalCertIfIcate
awarded







III. WDPK EXPEPIENCE:


12. 0etaIIs of PrevIous empIoyments, whether temporary or permanent, IncIudIng present empIoyment, If
any, are to be gIven :

Name and address
of the empIoyer
0esIgnatIon
PerIod of
empIoyment
SaIary drawn
rIef descrIptIon of
work handIed
Peasons for
IeavIng
From To











1J. Any other work experIence:






IV. EXTPA CUPPICULAP ACTIVITIES l HDIES :

14. PartIculars of partIcIpatIon In Sports, AthletIcs, Scouts,
NCC, 0ebates, 0ramas or other extracurrIcular actIvItIes : ....................................................

...................................................

...................................................

15. HobbIes and other Interests : .....................................................

.....................................................

.....................................................

:4 :

V. hISCELLANEDUS INFDPhATIDN:
Have you ever been arrested, prosecuted, kept under detentIon or bound
down/fIned/ convIcted by a Court of Law or any case pendIng agaInst you for any
offence InvolvIng moral turpItude: f yes, gIve full detaIls.

Have you ever been debarred/dIsqualIfIed by any nstItutIon from appearIng at Its
examInatIon/selectIon or debarred In any manner from any examInatIon, or
rustIcated by any UnIversIty or any other educatIonal authorIty/nstItutIon: f yes,
gIve full detaIls.

s any case pendIng agaInst you In any UnIversIty or any other educatIonal
authorIty/nstItutIon at the tIme of fIllIng up thIs attestatIon form: f yes, gIve full
detaIls.

n case you are/were an employee of the Covernment/PublIc Sector
DrganIsatIon/8anks/ |unIcIpal CorporatIon/PrIvate Sector DrganIzatIon, please state
whether there Is any dIscIplInary case pendIng agaInst you or whether any
dIscIplInary actIon was taken agaInst you durIng the last J years of your servIce; f so,
please gIve full detaIls.

Were you ever removed, dIscharged/dIsmIssed/made to resIgn from such servIce In
the past: f so, please gIve detaIls.


VI. PEFEPENCES:

16. PIease furnIsh for reference, the foIIowIng detaIIs of TWD respectabIe persons, NDT reIated to you.
1) Name 2) Name

Address



Address





PIn PIn
DccupatIon DccupatIon

Contact No.
wIth ST0 code

Contact No.
wIth ST0 code

|obIle No. |obIle No.

17. AddItIonaI InformatIon, If any, whIch you wIsh to furnIsh:


0ECLAPATIDN

....................................................................................., hereby declare that the above
statements are true, complete and correct and that no facts have been suppressed. t Is understood that
employment In the 8ank, If any, offered to me Is based upon the truthfulness of the statements made hereIn
and In the event of any InformatIon beIng found false or Incorrect, my appoIntment Is lIable to be termInated.
further state that, If selected, am wIllIng to be posted to any of the 8ranches/DffIces, IncludIng Fural
8ranches, of the 8ank.

undertake to abIde by the stIpulatIon of the bank that dIrectly recruIted DffIcers shall furnIsh to the 8ank a
8ank Cuarantee for Fs. 50,000/[Fupees FIfty thousand only] or a fIxed 0eposIt of CorporatIon 8ank for a
perIod of 2 years for the aforesaId amount by assIgnIng the same to the 8ank and that the dIrectly recruIted
offIcers shall execute an agreement to serve the 8ank for a mInImum perIod of 2 years after joInIng, faIlIng
whIch the offIcer shall be lIable to pay to the 8ank a sum of Fs. 50,000/[ Fupees fIfty thousand only] and J
months pay towards notIce perIod.

0ate:
PIace: SIgnature of the CandIdate