Application Format

Please fill in BLOCK Letters. Incomplete application shall be rejected.

To,
Please Paste
Assistant General Manager (A&L),
Hindustan Copper Limited / Indian Copper Complex (NOT Pin) a
PO - Moubhandar – 832103, recent
Dist – East Singhbhum, passport size
Jharkhand. colored
photograph

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

Advertisement No. - ………………………………………………………………………………………………………

1. Name:________________________________________________________________________
2. Father’s Name: ________________________________________________________________
3. Date of Birth (DD/MM/YYYY): ____________________________________________________
4. Correspondence Address:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
5. Mobile No.: __________________ Landline No. / Alternate No.: ______________________
6. Sex: _________________________
7. E-mail: ________________________________________
8. Domicile State: _________________________________
9. Category: Please Tick ( ) the applicable category: General / SC / ST / OBC / EWS
10. Marital Status: _________________________________
11. Academic / Professional Qualification (From 10 th / Matriculation onwards)

Board / Marks
Examination Year of Duration Of
University / Div. / Grade Obtained (%)
Passed passing Course
Institute
 12. Experience:

Whether Non-
Period ferrous or other
Name of Nature of work
Post held than Non-ferrous Remarks
Organization performed
From To industry.

13. Those who are working in Govt. / PSU / Semi Govt. are required to apply through proper
channel or produce NOC (No Objection Certificate) at the time of joining, failing which,
their candidature will not be considered.
14. Any other relevant details:
___________________________________________________________________
___________________________________________________________________

Undertaking:

I, hereby, certify that the information provided above is true to the best of my knowledge and in
case it is found to be false or incorrect or suppressed, the training shall be terminated forthwith
without prejudice to any legal / disciplinary action as deemed fit by the Management. I have gone
through full text of the advertisement and agree to all the conditions detailed therein.

___________________

(Signature of candidate)

Place:

Date:

Enclosures:

1. __________________
2. __________________
3. __________________
4. __________________
5. __________________
6. __________________
NB: Please use separate sheet if space is inadequate for filling Sl. Nos. 11 & 12. The format must
be same. Please sign on each page of the application form.