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Passport size
photograph to
be affixed.

(Form of application for appointment of Court Manager in

Goa Judiciary)
INSTRUCTIONS
To be filled up and submitted to the Office of the Registrar, High
Court of Bombay at Goa, Panaji-Goa on or before ................
Should any of the particulars furnished be found to be false to the
knowledge of the candidate, he/she will, if appointed, be liable to
be dismissed. The willful suppression of any material fact will be
similarly punished.
In case any of the columns are not applicable to the candidate
applying for the post, he/she should mention against the said
columns as not applicable

1.

Name in full, surname first (In Block

Capital letters

2.

Postal and telegraphic address in full

3.

Email Id, Telephone and/or Mobile No. :

if any

4.

Exact date of your birth and age (As :

on date of advertisement)

5.

Place of birth (Village, Taluka and :

District)

6.

Nationality at birth

7.

Are you a citizen of India?

8.

Do
you
belong
to
Scheduled :
Caste/Scheduled
Tribe/Other
Backward
Class
recognised
by
Government? Give the particulars as
to which of them you belong to.

9.

(a) Are you married?

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(b) If the answer to (a) is 'Yes', Do :
you have (i) more than one wife living (if a :
male)?
(ii) has married a man already having :
another wife (if a female)?

10.

(iii) Name of husband/wife

Number of children

Name (s) and dates of birth of the :

child/children

11.

Particulars of Qualification
commencing with Matriculation/
S.S.C. or equivalent Examination /
H.S.S.C.and then of Graduation, Post
Graduation etc.

: Name of
the
Board/
Universit
y

S.S.C.

H.S.S.C

Graduation

Post Graduation

M.B.A.

or

Advanced

Diploma

Year of
Passing

Division
with
percentage
of marks

in :

General Management.
Any other qualification
12.

Details
of
Computer
undertaken and Qualified

:
Duration
Course/s : Name of Name of
the
the
Computer Institution
Course/s
:

13.

Details of work experience such as :

name & address of the employer,
post held, pay scale, period of
service and nature of duties.

14.

Whether you have knowledge of :

Konkani?
Whether you have opted Konkani
subject in School/College?

15.

Give the names, postal address and :

profession of two referees, who should
be responsible persons, unconnected
with your school, University and not
related
to
you
testifying
your
character.

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16.

Whether you have been ever convicted :

of
an
offence
involving
moral
turpitude?

17.

Whether you have been permanently :

debarred or disqualified by the High
Court or the Union Public Service
Commission or any State Public
Service Commission from appearing
for
examinations
or
selections
conducted by it ?

18.

Details of Examination fee

D.D.No...........date........................
:
Amount ........Issuing Bank and place

Date : ........................2014

Signature of the Applicant

D E C L A R A T I O N

I, the applicant______________________________do hereby affirm

that all the details filled up in the application are true and correct as per my
knowledge. If any information is found to be false/incorrect, I will be liable
to be disqualified from the process of selection and if selected/appointed, my
services would be liable to be terminated without any notice.

Date : .......................2014

Signature of the Applicant

D E C L A R A T I O N
FORM A
I, Shri/Smt./Kum. _________________________________________
son/daughter/wife of Shri. ______________________________________
aged______ years, resident of ___________________________________
____________________ do hereby declare as follows :1. That I have applied for the post of ____________
2. I have _______________ (Number) living child/children as on today
out of which _______ (Number) child/children is/are born after 28 th
April, 2005 is ________________ (If yes, mention dates of birth).
3. I am aware that, if total number of living childern are more than two
due to the children born after 28 th April, 2006 I am liable to be
disqualified for the said post.

Place :
Date :

(Signature)