‘TAMILNADU CIVIL SUPPLIES CORPORATION: HEAD OFFICE, CHENNAI ‘APPLICATION FORM. (for the posts of Assistant) Post applied for ASSISTANT |Advertisement No. and Date Please affix recent Passport size phot here Name of the Candidate (IN BLOCK LETTERS) Gender (Tick in relevant Box) Male Female [Other Date of Birth Date Month Year [Age as on Ast July of the year 2019 in completed years) Father's Name Mother's Name Marital Status (Tick in relevant Box) Married lUmmartied Spouse Name Husband / Wife if applicant is female Widow Destitute widow others 10 Place of Birth 1 Native District and State 2 [Mother Tongue B JOther languages known 4 Nationality (Tick in relevant Box) Indian Others 15 Religion (Please specify) 16 |Address for Communication Door No. street: city/ Village: Dist State: Pincode: 7 Permanent Address: Door No. street: City/ Village: District: State: Pincode: 18 Communal Category (Please tick in relevant box) oc BC MBC sc SC{A) st DNC 19 Name of the Sub-caste |Community Certificate No. Date of Issue Date [Month Year© [Issuing Authority d_|Name of the Taluk: |Name of the District: Mediumof| Nameofthe | Yearof] Total | Marks Grade/ 20 |Educational Qualification Taisen | ieananisne | passing | ntarhs || secured aoe a |SS.LC. b H.C. (+2) ¢ |Under Graduate [Regular/Distance] d. Post Graduate [Regular/Distance] @ |computer on Office Automation £ others & Experience intermed] ‘Name of the mel Grade/_ 21 [Technical Qualification tower vite Higher Tnatitetion \YeRr oFassing| oe a |Typewriting Tamil b |Typewriting English ¢ [Shorthand Tamil d Shorthand English ‘Name and address ofthe | Designation | Scale of Pay From Details of Present Employment if Institution lany 22 Details of conviction/ Punishment / Disqualification / Criminal case, disciplinary proceedings etc., if Priority ifso, give details with jdocuments 23 24 25 |Mobile No. / Phone No. 26 |E.mail address 27 |Dectaration:- Thereby, declare that all the particulars furnished in this application are true, correct and complete to the best| lof my knowledge and belief. In the event of any information being found false or incorrect or eligibility being detected lat any stage, action can be taken against me by TNCSC. Date: Place: Signature of the Candidate Encl.; 1) Self attested Xerox copies of Certificates 2) Recent Passport size photograph 2Nos.