Railway Recruitment Cell

South Western Railway, Hubli Please affix/paste recent

Application Form for Recruitment of Candidates against Sports Quota (Open Advertisement) for the year 2015-16 for Group ,C' posts in
color Passport size
PB-l {5200-20200GradePayt"1900/2000 anderstwhileGroup'D'postsinPB-t -.5200-20200Gradepayt.1800/- Photograph (not to be
pinned) without cap &
without coloured glasses
Read the instructions careful before you start fi up the Application Form) (not older than three
UniUPost applied for (please tick (r,) appropriate Box) months) duly attested by
signing partially on
Group'C' PB-l <. 5200-20200+Grade Pay {.1900/2000
application and partially on
Erstwhile Group'D' PB-l <. 5200-20200+Grade Pay {.1800/- the photo

Hubballi Bengaluru Divn. Mysuru Divn.

Zonal Hqrs quota
Divn. Quota quota Quota

1. Name of the candidate

(Write in CAPITAL letters, as per
matriculation certificate)

2. Fatheis/Husband's Name

3,D.leofBirlh:o"t"|-Tluonm|-Tl"*,|_T_-rTl4'Natjonality:
6.Address for Correspondence(write in CAPITAL letters)

7 Community S.Gender

Tick(.,t) the appropriateBox Tick({) the appropriateBox

UR OBC SC ST Male Female

State: Pin Code: 9.Nearest Railway Station:

11.Email
l2.Details of Educational Qualification

Examination Passed School/lnstitution / Board/Ulriversity Marks

Year of passing %age of marks Certificate No. Class/ Division
obtained

'l3.Details of Sports achievements :

The details of Sports achievents should be submitted in Annexure 'l' to this Application.

l4.Personal marks of ldentification(Scars, moles,or any other visible 1

permanent marks on the body )

2.
15. Details of Present emPloyment in Railways or any other Government,organisation (for serving employees) (to be supported
by attested copies of certificates).
Designation Pay Band { Grade Pay { Date of entry to
U nit/Office/Divn/Workshop
present qrade

16. Whether belonging to the following categories(Tick(r/) the appropriate Box) (to be supported by attested copies of certificates)

Ex-Service Economically Widowed but not J udrcrally

Divorced but not 17. Detais of IPO's Enclosed (examination fee)
Minority separated but not
man backward class remarried remarried
remarried IPO No Date Amount

lS.DELCARATION BY THE CANDIDATE

I hereby declare that all the infonna
ot the information given herein being found false or incorrect my candidature for the recruitment on sports quota is tiabll to
be rejected or cance ed. tn the event of
my misstalemenu discrepancy in the pa(iculars being detected afier my employment, my services are tiable to be
teminated with;ut any notce io me.
I also declare lhat, in the event of my seleclion against Sports Quota quoia, I wlll activety participate
regutarly ln the uniugroup activitles and coninbute towards
the service program/prcjects whenever called for.

Left Hand Thumb impression(Must be ciear anO not smuOge{

Place 1 2

Date
Signature of the Candidate
(Do not sign in the capital letters)
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