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Indian Oil Corporation Limited

(A Government Of India Undertaking)

Application form (Personal & Confidential)

Please take the print out of the application form in A4 size portrait format only GATE Reg. No. # Indianoil Reg. No.# Date Post Applied Preference1 Preference2 Candidate's Name Father's / Husband's Name Relationship Date of Birth Gender Choice for Interview Centre Contact No Email Id Are You presently in Employment with IOCL Category : EE-200309071 : 545041 : 30-01-2014 : Both(Officer/ Engg & Asst Officer/ Asst Engg) : Asst. Officers : Officers : Mr.JALAPATI PHANEENDRA : JALAPATI NAGARAJU : Father :10-06-1993 : Male : Chennai : 8500108805 : phaneendra019@gmail.com : No : SC

Paste your recent self attested Passport size photograph and it should be the same as submitted along with GATE Application form

Name of Caste/Community MADIGA Date of Issuing Caste cert. 02-06-2008 Caste cert. issuing authority MANDAL REVENUE OFFICE State of Origin / Domicile Religion Whether belong persons with Disabilities(PWD)? Whether Ex-Serviceman Domiciled in JK (between 01.01.1980 and 31.12.1989) Marital Status Discipline Applied For Discipline Code Educational Qualification Details Name of Degree Branch / Name of the Course Month & Year of Passing Course Duration Whether Full time Regular Course whether Completed % of Marks College / Institution Name Name of Affiliate University Course Approved by AICTE : B.Tech. : Electrical & Electronics Engineering : 04-2014 : 4 Y - 0M : Yes : Yes : 77 : MGIT : JNTUH : Yes Permanent Address if different from above Address1 : H.NO:2-111B SC COLONY Address1 : GOTURU VILLAGE City / Town : THONDURU MANDAL State : ANDHRA PRADESH Pincode : 516390 : KADAPA : ANDHRA PRADESH : Hindu : No : No : No : Unmarried : Electrical & Electronics Engineering : EE

Address for Correspondence Address1 : H.NO:2-111B SC COLONY Address2 : GOTURU VILLAGE City / Town : THONDURU MANDAL State : ANDHRA PRADESH Pincode : 516390 Nearest Railway station

All the information given in this application form are true to the best of my knowledge and belief. If any of the information is found incorrect, my candidature may be cancelled. Date: Signature: CANDIDATE TO PLEASE NOTE: 1. Please note your IOCL registration no. for future reference 2. Please visit our website after about 3 weeks of declaration of GATE 2014 result for further information. 3. Please retain the photograph uploaded for GATE 2014 application. If you are shortlisted for further selection process. Same photograph may be required to be uploaded. 4. Mobile no. and email ID mention in this application form should remain valid for at least next one year. 5. If you are shortlisted for interview you will be required to produce this application form. 6. You may contact our helpline number 1860 354 0112 or write to us at recruit2014@indianoil.in