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APPLICATION FOR THE POST OF Assistant Excise Guard

Affix photograph on
the copy of this
application while
submitting the same
along with attested
copies of documents

1. FULL NAME OF THE APPLICANT:

______________________________________________
(IN BLOCK LETTERS ONLY)
(Surname
First Name

Middle Name)

2. SEX: _______________ (MALE / FEMALE)
3. ADDRESS :______________________________________
_______________________________________
____________________________________

4. PHONE: ________________________________
5. E- MAIL ID/ADDRESS: (optional)

_____________________________

6. EPIC NUMBER: __________________

7.

AADHAR NUMBER : _______________

8. RELIGION: _______________________
9. CATEGORY: _____________________________________________________________
10.

(SC / ST / OBC / Ex-Servicemen / Children of Freedom Fighter / Physically Handicapped/ General)
(Certificate attached)
DATE OF BIRTH: ___________________________

11. PLACE OF BIRTH: __________________________
12. MARITAL STATUS: __________________ (Single / Married / Widow / Widower)
13. Extracurricular Activities: (like Sports, Cultural, NCC and participated at Taluka / District / State /
National Level competition as per criteria laid down) i.___________________________________
(certificates attached)

ii.__________________________________
iii.__________________________________

14. EDUCATIONAL QUALIFICATIONS:
(certificates attached)

i.___________________________________
ii.___________________________________
iii.___________________________________

15. OTHER QUALIFICATION:
(certificate attached)

i.___________________________________
ii.__________________________________
iii.__________________________________

16.

LANGUAGES KNOWN:

17.

WHETHER REGISTERED WITH EMPLOYMENT EXCHANGE: __________ (YES / NO)

18.

VALID EMPLOYMENT REGISTRATION NO. : ________________________ (card attached)

19.

WHETHER RESIDENT OF GOA FOR LAST 15 YEARS: ________________

___________________________________

(YES / NO)

(Valid Residential Certificate attached)

20.

PHYSICAL REQUIREMENTS:

HEIGHT: _______ FEET _______ INCHES
CHEST MEASUREMENT: __________ INCHES.
(not applicable for women candidates)

21.

Work Experience if any (provide details) : i._______________________________
(certificate attached)

ii._______________________________
iii.______________________________

22.

Knowledge of Computers if any: ____________________________
(certificate attached)
Declaration

Cultural.__________________________________ 14.__________________________________ iii. LANGUAGES KNOWN: 17. Extracurricular Activities: (like Sports. Work Experience if any (provide details) : i. E. OTHER QUALIFICATION: (certificate attached) i.I declare that whatever information provided above by the undersigned is true and correct. FULL NAME OF THE APPLICANT: ______________________________________________ (IN BLOCK LETTERS ONLY) (Surname First Name Middle Name) 2. PHONE: ________________________________ 5. EDUCATIONAL QUALIFICATIONS: (certificates attached) i. Place:- ___________________ Date:- Signature of the Applicant APPLICATION FOR THE POST OF Peon Affix photograph on the copy of this application while submitting the same along with attested copies of documents 1.______________________________ . SEX: _______________ (MALE / FEMALE) 3.___________________________________ (certificates attached) ii._______________________________ iii. PLACE OF BIRTH: __________________________ 12.__________________________________ 16.MAIL ID/ADDRESS: (optional) _____________________________ 6. AADHAR NUMBER : _______________ 8. MARITAL STATUS: __________________ (Single / Married / Widow / Widower) 13._______________________________ (certificate attached) ii. for any false declaration made or false certificates attached.___________________________________ ii.__________________________________ iii. VALID EMPLOYMENT REGISTRATION NO. EPIC NUMBER: __________________ 7. RELIGION: _______________________ 9. I understand that I shall be held liable and for the consequences thereon. CATEGORY: _____________________________________________________________ 10. NCC and participated at Taluka / District / State / National Level competition as per criteria laid down) i.___________________________________ iii. ADDRESS :______________________________________ _______________________________________ ____________________________________ 4. (SC / ST / OBC / Ex-Servicemen / Children of Freedom Fighter / Physically Handicapped/ General) (Certificate attached) DATE OF BIRTH: ___________________________ 11.___________________________________ ii.___________________________________ 15. : ________________________ (card attached) 19. WHETHER REGISTERED WITH EMPLOYMENT EXCHANGE: __________ (YES / NO) 18. WHETHER RESIDENT OF GOA FOR LAST 15 YEARS: ________________ ___________________________________ (YES / NO) (Valid Residential Certificate attached) 20.

Place:- ___________________ Date:- Signature of the Applicant Note: The applicants should provide two passport size photographs. (vi) Certificate issued by the Competent Authority in respect of the reserved category (if applicable). (ii) Valid employment exchange card. I understand that I shall be held liable and for the consequences thereon. than a valid proof of date of birth will have to be submitted like Std X/SSCE passing certificate or any other evidence /proof. where the applicant was/is employed. one affixed on the application form and 2nd to be submitted along with the application alongwith attested copies of the following documents: (i) Certificates of Educational Qualifications and marksheets. Knowledge of Computers if any: ____________________________ (certificate attached) Declaration I declare that whatever information provided above by the undersigned is true and correct. In the event the applicant does not have a Birth Certificate. . (viii) Certificate of work experience issued by the employer. and (vii) Certificate indicating other qualifications possessed by the applicant including those pertaining to Computer education. (iv) Birth Certificate. for any false declaration made or false certificates attached.21. (iii) Valid 15 years residential certificate issued by the competent authority.