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Application Form against Advertisement dated 4th-10th July 2015

* POST APPLIED FOR (alongwith specialized area) __________________________________________


Fields marked * are mandatory, in case full information is not filled, the Application Form will be rejected.

* Paste a selfattested passport size


photograph here

1. Personal Details

* Name of the Candidate


Gender (Male / Female)

: ____________________________

* Fathers / Husband Name

: ____________________________

Date of Birth (dd/mm/yy)

: _________________________
: _________________________

(Attach copy of Class Xth Certificate / School leaving Certificate with hard copy of Application
Form)

Category
* (Gen. / SC / ST / OBC)

_____________________________

(Attach copy of Caste Certificate in case belongs to reserved category with hard copy of Application
Form)

* Whether belong to

: _________________________

with Disability (PwD)


(Yes / No)

(Attach copy of Disability Certificate with hard copy of Application Form)

: _____________________________

Whether applicant is
Ex-Serviceman (Yes / No)

: _________________________

: _____________________________

Landline No. (with STD code)

: __________________________

Minority (Yes / No)


Marital Status

* Is the applicant Person

(Single / Married)

Mobile No.
Complete Permanent
* Residential Address

_____________________________

: _____________________________

* E-Mail

: __________________________

Complete Current
* Residential Address

: __________________________

_____________________________

__________________________

____________________________

__________________________

_____________________________

__________________________
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2. * Education Qualification (starting from 10th class to Graduation):


Examination Passed

Full Degree Name, in case of


Graduation

Name of the Board / University


/ Institute

Year of
Passing

Whether Regular / PartTime / Distance

Percentage
obtained

10th
12th
Graduation
(B.A., B.Com, B.Sc etc.)
Use extra sheets, if required. Attach copies of all mark sheets, certificates duly self-attested with hard copy of Printed Application Form.

3. Professional Qualification (Masters / Post-Graduation / CA / ICWA etc.):


Full Name of Degree / Course

Name of the University /


Institute

College Name

Duration
of the
Course in
Years

Year of
Passing

Whether
Regular/
Part Time /
Distance

Specialization /
Discipline

Percentage
/ Grade
obtained

Use extra sheets, if required. Attach copies of all mark sheets, certificates duly self-attested with hard copy of Printed Application Form.

4. Additional Qualification/Training attended (if any):


S.No.

Full Name of Qualification / Training

Duration

Details (in brief)

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5. * Details of complete experience starting from the present employer:


(only after Graduation Experience has to be mentioned)
S.No.

Name of Employer

Position
held

Executive
or NonExecutive

Duration of Position held


From
To
Date
Date

Job Profile (in brief)

Gross Salary
per month
(in Rs.)

Use extra sheets, if required. Attach copies of all experience certificates duly self-attested with hard copy of Printed Application Form.

6. If presently working with Government / Semi-Government / PSUs/Banks / Local Bodies etc., please give Name & Address of HR
Head / Personnel Department.
Name & Address of the HR Head / Personnel Deptt. : ________________________________________________________
_________________________________________________________

7. * Have you ever appeared in interview for any post in NSIC during last 3 years? :

Yes _____ / No _____

In case Yes, provide the following details:


Name of the post : ________________________ Year of interview : ________________________

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8. * References with complete Name, Address and Telephone Number:


(1) Reference No.1
Name
Address

________________________________

________________________________

(2) Reference No.2


Name
: ________________________________
Address

________________________________
Telephone

________________________________

: ________________________________
________________________________

Telephone

: ________________________________

Place of Submission : ____________________________________

* Date: ______________
Self-Declaration of applicant:

Yes

(a)

I have verified the above details, and the details are in order to the best of my knowledge & belief.

(b)

I understand that merely filling this Application Form will not be treated a complete application. Therefore, I further declare that I will send this
Application Form with self-attested photo pasted at appropriate place, copies of all self-attested credentials of caste, disability, work experiences,
qualification to DGM(HR), NSIC Ltd. so that the same is received on or before 28.07.2015.

* Signature of Applicant
Fields marked * are mandatory, in case full information is not filled, the Application Form will be rejected.

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