Apblication Format for Walk-in-Interview (it should be submitted duringiattending Walk-in-interview. No need to submit through either post or email) Name of the Post Applied for: Name of the candidate: Please paste a Date of Birth (as per 10" Mark sheet/Certificate): latest self attested e a Passport size color Age on 1* January 2020 (As pér 10 Marksheet/certificate) Rae or athens Nome::ctorereaee eee peeve candidate Sex(male/Femal Married/Unmarried: Identity Document: a 2 3 4. 5. Categories(GN/OBC/SC/ST/PWD):. 6 7 8 9. Identity Document number: 10. Any criminal proceeding/vigilance case/departmental proceeding is pending or not against the candidate (Yes/No): 11, Ifthe candidate had been convicted/penalized in any criminal/departmental proceeding (Yes/No) : 12. Correspondence Address (With Pin code): Phone No.. E-Mail ID. 13. Permanent Address (With pin code): Phone No. E-Mail ID. 14, Educational Qualification(Start from 10" onward) : [SIN] Pearce Name | Subject? Sehool7 | Board? | Gourse | Passing | Total | Marks | Porcentage | Division Speciatzat | Col University | Typo | outYear | Marks | Obtained | orarks | Grado ion Tinstute (Regular i Distancer parttime) eeN ]Bearee Wane | Subject? | School7 | Board? | Course | Passing | Total | Marks | Parcentage [| Divsion/ Specializat | College | University | Ty outvear | Marks | Obtained | of Marks | Grade ion Tinstitite (Regular = i Distance! i Part time) 2 a 5 15, Description of Experie! ent Employment): Sav] Employer Employer | Nameot [Nature of | Pace of | Start | Enddate | Total | Relevant work name’ ‘Address | Post Employme | Posting | date experiene | description Designatio . euumaryy) ; regulat) le oi 2 ysl | 3 | | 4 i a 2 6 t 16, Declaration by candidate 7 Pla Dat Thereby declare that all the statement made by me in this application is true and complete to the best of my knowledge and belief and nothing has been concealed or distorted. | am ‘aware that if at any point of time | am found to have concealed/distorted any material information, my candidature or appointment is liable to be summarily terminated without notice. Signature of the Candidate