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vkosnu i=
dk izk:i

For office use only

1- Application No.
EDM......................................
2- Date of
receipt:...................................................
3- DD attached? Yes/No.
4- Application Accepted/Rejected5- Reason (if rejected)-----------------

APPLICATION FORM FOR THE POST OF e-DISTRICT MANAGER HARDOI

First Name *
Father/Husbands
Name*
Address for
Communication*
Permanent Address *

Note:- FILL IN ONLY CAPITAL LETTERS (Use only blue ball pen) A4 size paper
Surname*
Gender*

Address 1*
Address 2
Pincode *
Address 1*
Address 2
Pincode *

State *
District *
Photo Self
Attested

State *
District *
Age ( As on 1st
April, 2013)

Date of Birth*
(DD/MM/YYYY
Email ID*
Contact No (Mobile)*

Contact No
(Landline)

Qualification *
S.No.

Qualification

Post Graduation

Graduation

12th

10th

Languages Known

Name of
Institution/University

Year of Passing

Marks in %/CGPA

Read

Write

Speak

From Date (Month/Year)

To Date
(Month/Year)

Designation

Type (Full
time/part
time/distance)

Hindi
English
Other
Work Experience
Name of
Employer

Total Experience
(In Months)

1
2
3
Photo ID Proof*
#
#
#

Attested copies of all document (By Gazetted Officer) should be attached with the form.
The original copies of educational qualifications, experience certificate, Address proof and photo ID proof should be carried along at the time of interview.
Preference will be given to those applicants who reside in Hardoi.

I hereby declare that all the statements made in my application and the attached job application form are true, complete and correct to the best
of my knowledge and belief. In the event of any information being found false or incorrect at any stage, my application is liable to be rejected and if already
appointed, my services are liable to be terminated without notice.

Dated:Signature

Applicant