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APPENDIX ‘A’

CONSORTIUM
(Incorporated under the IR Act, 1908)

Affix your
recent passport
size photograph
(Note: Application form to be filled in by the candidate in block letters with
and sign across.
black ball point pen only.)

Demand Draft (DD) Number………………………………………………………

Name of the post applied for…………………………………………………………………………

Code of the post applied for………………………………..

Test Centre Code: 1st preference………………………… (Write down numeral code only)
(See Annexure ‘B’)
2nd preference…………………………

GENERAL INFORMATION

1. Name in Full: ……………………………………………………………………………………….

2. Mother’s Name: …………………………………………………………………………………....

3. Father’s/Husband’s Name: ………………………………………………………………………..

4. Date of Birth: Day…………….. Month……………. Year…………………..


(DOB as recorded in Matriculation or equivalent certificate)

5. Age: ……………..Years ……………….months (in numerals only)


(Age as on the last date fixed for the receipt of application i.e. 18/12/2010)

6. Nationality: …………………………………………………………………………………………

7. Marital Status: Married/Unmarried/Divorced …………………………………………………..

8. Sex: Male/Female……………………………...

9. E-mail id: …………………………………………………………………………………………...


10. Mobile Number: (+91)…………………………………….……… (Enter the ten digit no. only)

11. Address for Correspondence:

...……………………………………………………………………………………………………..

……………………………………………………………………………………………………….

……………………………………………………………………………………………………….

…………………………………………………………… Pin Code……..…………….

12. Permanent Address:

………………………………………………………………………………………………………..

………………………………………………………………………………………………………..

………………………………………………………………………………………………………..

…………………………………………………………… Pin Code………………......

13. Educational Qualifications:

Examination Board/University Year of Total Marks % of Stream


Passing Marks Obtained marks/
equivalent
GPA
Matriculation
(10th)

Higher
Secondary
(12th)
Bachelor’s
Degree

Master’s Degree

Any other
Degree/Diploma
14. Professional Experience (Starting from the latest): (Please write N/A if not applicable)

Designation Name of the Net Monthly Job Profile Period of Service


Organization Salary

DECLARATION

I hereby certify that the above information furnished is correct to the best of my knowledge
and belief. I have not suppressed any material fact or factual information in the above
statement. I am aware that in case I have given wrong information or suppressed any material
fact or factual information or I do not satisfy the eligibility criteria according to the
advertisement, then my candidature will be rejected/services terminated even after permanent
employment without giving any notice or reasons thereof.
I hereby certify that I am satisfying the eligibility criteria for the post applied, in terms of the
advised criteria in respect of age and educational qualification.
I am also willing to serve anywhere in India. I agree that the CONSORTIUM has the right to
transfer me to any part of the country and/or to any job position at its sole discretion in terms
of applicable staff rules from time to time.
I have read the instructions and conditions carefully and I undertake to abide by all the terms
and conditions in the advertisement given by the CONSORTIUM. I hereby agree that no legal
proceeding in respect of any matter or claims or dispute arising out of said advertisement shall
be instituted by me.

Place: ………………………………

Date: ……………………………… Name and signature of Applicant


APPENDIX ‘B’

CONSORTIUM
(Personnel Directorate: Recruitment Section)

Admit card for the various posts of CONSORTIUM

Registration Number…………………………………………... (To be filled by office)

Roll Number……………………………………………………. (To be filled by office)

1. Name of candidate………………………………………………………….
Affix your recent
2. Father/Husband’s Name…………………………………………………… passport size
photograph and
3. Date of Birth………………………………………………………………… sign across.

4. Visible identification mark………………………………………………….

5. Postal Address with Contact Number

….. ………………………………………………………………………………………………......

…..……………………………………………………………………………………………….......

……..…………………………………………………………………………………………………

……………………………………………………………………………………………………….

……………………………………………………………………………………………………….

(For office use only)

You are required to appear for the selection test on ……………………………………………….

At 10:00 A.M. at ……………………………………....………………………………………………

………………………………………………………………………………………..

………………………………………………………………………………………..

………………………………………………………………………………………..

………………………………………………………………………………………..