Notification No: ADE3/9338/542 Dated: 08/06/2016

APPLICATION FORM FOR

Part Time Temp. Clerk cum Computer Operator
LAST DATE FOR SUBMISSION OF
COMPLETED FORMS: 01/08/2016
1) Full Name (In Block Letters):
2) Nationality:
3) Contact Details:
a. Residential Address:
b. Mailing Address:
c. Contact Phone No.:
d. Email Id:
4) Date of Birth:
5) Gender:
6) Marital Status:
7) Whether belonging to SC/ST/SEBC:
(Attach a Certificate, if applicable)
Paste Recent
Passport Size
Photograph

8) Academic Qualifications (From SSC onwards):

Sr. No.

Examination
Passed:

Year of passing:

Institution:

Subjects:

Class and/
Percentage
Grade

9) Please attach attested/ self-attested photocopies of documentary evidence. The candidates are
requested to bring the originals with them at the time of interview for verification:
Name of the Institution.
Designation
Nature of Duties Pay
Date of
Date of
Joining
leaving

10) Names. Designations, address, e-mail and contact phone numbers of three references:
1.
2.
3.

Vadodara
Date:

Name and Signature of Candidate