No Graduate

(For office use only) Diploma Holder

Programme for placement of graduates who have been unemployed for more than one year
after graduation before 01.01.2020 - 2020
Application Form
Personal Information

1. Name in full :……………………………………………………………………………

2. NIC number :

3. Male: Female: (Pl mark “X” in the relevant box)

4. Telephone number :

5. E-mail address:……………………………………………………………………………………………………

6. Date of Birth : (YYYY MM DD)

7. Address :…………………………………………………………………………………………………….…………………………………………

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

8. District : ……………………………………….………………

Educational Qualifications

9. Degree or an equivalent qualification in (Pl mark “X” in the relevant stream):

i. Graduate Diploma holder
ii. Related subject area

Arts Commerce Management Accountancy

Ayurveda Allied health Science

Computing (IS/IT/CS/SE) Any others (specify)

10. Valid from : (YYYY MM DD)

11. Internal: External: (Pl mark “X” in the relevant box)

12. Name of the university :……………………………………………………………………………………………………

13. Country :……………………………………………………………………………………………………
14. Subjects studied :……………………………………………………………………………………………………
:……………………………………………………………………………………………………
:……………………………………………………………………………………………………
15. The Ministry or the Department where placement is expected:

(Indicate your choice in order of preference from 1 to 11 of the list given below)

Rural and Estate schools Survey Department

Divisional Irrigation Offices Agricultural Farms/Projects Service

Centres
Agrarian Service Centres Rural Minor Export Crops Offices

Divisional Wildlife Offices Department Of Valuation

Local Ayurvedic Hospitals Department Of Immigration &
Emigration
Rural Hospitals / Dispensaries

Declaration by the Applicant

I do hereby certify that the particulars given above are true and correct to the best of my knowledge and
that I was not employed during the immediately preceding one year period.

I would like to take up employment at field level including the above - mentioned Rural / Regional
schools, Hospitals.

……………………………………………………… ………………………………
Signature of applicant Date

Recommendation of Grama Niladhari

I hereby confirm that the applicant has been unemployed for more than one year after graduation and
that he/she is permanently resident at the above address

Name of Grama Niladhari :………………………………………… Division and Number: ………………………………………

Signature and Rubber stamp: Date:

Recommendation of Divisional Secretary

I hereby countersign in confirmation of the particulars forwarded by the Grama Niladhari and the fact
that applicant is unemployed.

Signature of Divisional Secretary :……………………………………

Divisional Secretariat :……………………………………

Rubber stamp: Date : ………………………………