Application Form for Assistant Project Coordinator SSB-

Phase,2

1. Application for the post…………. …………………. …………. ….

2. Name (in Block letter)………………………………………………

3. Father’s/Husband’s name…………………………………………..

4. Permanent address …………………………………………………

Recent
…………………………………………………. passport
5. Mailing address ……………………………………...................... size
photograph
……………………………………………………..
6. Date of birth …………………………………………………………….

7. Age as on 01 January 2016 ……………………………………

8. Sex (M/F) …………………………………

9. Nationality……………………………………………………………………..

10. Educational/Professional/Technical Qualifications

Examination/ Board/University Year of Subjects Division/percentage

Degree/Diploma passing
of marks

11. Publications if any …………………………………………………………

12. Details of experience……………………………………………………...

13. Details of present employment…………………………………………..

14. Extra curricular activities …………………………………………………

15. Employment Exchange Registration number and address of the employment

exchange (if any)………………………………………………………………

16. Experience Detail ……………………………………………………………

Declaration
I …………………………son/daughter/wife of……………………… hereby declare
that all the statements made above are complete and correct to the best of my
knowledge and belief. In the event of any information found false or incorrect at
any time before or after the examination/interview/selection, action may be taken
against me and I shall abide by the decision of the Secretary, UOCB, Dehradun.

Note : Complete Bio data along with self attested photocopies of marksheet & certificates and experience
certificates must be annexed with this application form

SIGNATURE OF THE APPLICANT