SPECIMEN APPLICATION FORM

” or
Shall be filled with Block Capital Letters, whereas applicable write the correct numbers, letters “

” in the boxes.
“

01. Post Applied for

02. Name
02.1 Name in full: ...................................................................................................................................
...............................................................................................................................................................
02.2 Name with initials: ..........................................................................................................................

03. National Identity Card Number

04. Sex: Male (M), Female (F)

05. Civil Status: Married (M), Unmarried (U), Other (O)

06. Date of Birth:

Y Y Y Y M M D D

07. Age as at 28-07-2017

Y Y M M D D

08. Permanent Address: ...............................................................................................................................

...............................................................................................................................................................

09. Address for communication purposes: ...................................................................................................

...............................................................................................................................................................

10. Contact Numbers:

Mobile Residence

11. E-mail Address: ......................................................................................................................................

12. Qualification Stream: Electrical Civil

13. Qualification: Code No. 1. 2. 3. 4. 5.

(Please refer the Advertisement)

14. Post qualifying experience (For or NCT holders only): .............................................................................

...............................................................................................................................................................

15. Medium for recruitment examination: Sinhala English Tamil

(Please select one)

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16. Declaration by the applicant:
I do hereby declare that all the facts given above by me are true and correct to the best of my
knowledge. I am also aware that if the information given above or subsequently on demand is found to
be false or incorrect before selection, I will be disqualified and if revealed after appointment I am liable
to be discontinued from service without compensation. I am further aware that any form of canvassing
in this connection will disqualify me during any time of the selection process.

Date: Signature

17. Certification of the Head of the Department:

The application of Mr. / Mrs. / Miss ……………………………………………………………………………………….………………
is submitted herewith. I certify that he/she is employed in this Institution / Department as permanent /
temporary / casual employee. I hereby inform that he/she can/cannot be released from the present
post if he/she selected for the above post.

Date: Signature of the Head of the Department