Registration no.

:
GHAZIABAD UNIT

APPLICATION FOR POST OF CONTRACT ENGINEERS

1. Name in full : (Mr./Ms.) :

(As per SSLC Certificate)

2. Age as on 31.07.2015 :
& Date of Birth
Photo to be self
3. Sex : M/F :
attested by the
4. Fathers Name : candidate.

5. Nationality :

6. Category-General/SC/ST/OBC :
(Enclose Certificate in Prescribed Format)

7. a)Indicate if you are a person With Disability : OH VH HH

If yes, indicate nature of Disability.
(Disability certificate in the prescribed format to be enclosed)

b) Degree of disability as indicated in the Certificate:

8. Religion: Hindu/Muslim/Christian/ Sikh / Neo-Buddhist/

Zoroastrian, other (Please specify) :

9. Qualification: (Academic/Professional) :
(Indicate division &year of passing)

Educational Institution/University Main subject Class secured/ Year of passing

status from percentage of
SSLC Onwards marks

10. Details of Experience (if any):

Sl. Name of the From To Designation/ Emoluments Nature of

No. Organisation (dd/mm/yy) (dd/mm/yy) Rank responsibilities
in brief

(Enclose separate sheet if required)

11. Address with pin Code

Permanent Address Correspondence Address

Telephone Telephone

a) Mobile No: b) E-mail

12. Additional information if any:

(Attach additional sheets if necessary)

13. Undertaking

I affirm that the information given above is true and correct, I further declare that if any at stage
it is discovered that an attempt has been made by me to willfully conceal or mis-represent facts,
my candidature may be summarily rejected or my employment terminated. In the event of my
selection for the post of Contract Engineer, I am willing to be posted at any of the sites of BEL
or its customers.

SIGNATURE OF THE CANDIDATE

Date:

Place: