Application format for DMA

Government of Karnataka AFFIX RECENT

Directorate of Municipal Administration PASSPORT SIZE
9 &10th Floor, Vishweswarayya Tower, AmbedkarVeedhi, PHOTO
Bangalore – 560 001

Application format for various positions in DMA

APPLICATION FOR THE POST OF ……………………………………………..

1. NAME OF THE APPLICANT (as in SSLC marks :
card):
2. DATE OF BIRTH (DD/MM/YY): :
3. AGE (AS ON CLOSING DATE) :
(SSLC marks card to be enclosed for age
proof)
4. NATIONALITY :
5. GENDER
6. PERMANENT ADDRESS :
7. ADDRESS FOR COMMUNICATION :
8. CONTACT PHONE NO : Land line:
Mobile:
9. EMAIL ID(a valid email has to be obtained, :
the shortlisted candidate will only be
contacted through given email)

10. EDUCATIONAL QUALIFICATIONS: (SSLC onwards)

EXAMINATION
NAME OF THE % OF
SL. COMPLETED/ YEAR OF MAXIMUM MARKS DIVISION/
INSTITUTION & MARKS
NO. DEGREE COMPLETION MARKS OBTAINED CLASS
UNIVERSITY OBTAINED
OBTAINED
1
2
3
4

11. TECHNICAL QUALIFICATIONS: (Computer course etc)

EXAMINATION
NAME OF THE % OF
SL. COMPLETED/ YEAR OF MAXIMUM MARKS DIVISION/
INSTITUTION & MARKS
NO. DEGREE COMPLETION MARKS OBTAINED CLASS
UNIVERSITY OBTAINED
OBTAINED
1
2
3
4

7. Membership of Professional Associations:

1
2
12. Trainingsundergone relevant to the position:
1
2

13. EXPERIENCE(Post qualification experience)

i. PRESENT ORGANIZATION:
a. Name & address of the organization:
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Application format for DMA
b. Designation held:
c. Duration (from-to):
d. Tasks performed:

ii. PREVIOUS ORGANIZATION (S): (Give details of all the organizations where applicant has
associated, use as many sheets required)
a. Name & address of the organization:
b. Designation held:
c. Duration (from-to):
d. Tasks performed:

14. References (Referred persons may be contacted by the DMA):

References No.1 References No.2
Name: Name:
Designation: Designation:
Relationship with Applicant: Relationship with Applicant:
Address: Address:
Contact Phone: Contact Phone:
Email: Email:

15. Languages known:

Language Speak Read Write

16. Certification:
I hereby declare that all the statements made in my application and the attached job application
form are true, complete and correct to the best of my knowledge and belief. In the event of any
information being found false or incorrect at any stage, my application is liable to be rejected and
if already appointed, my services are liable to be terminated without notice.

SIGNATURE OF THE CANDIDATE:

NAME OF THE CANDIDATE:
DATE:
PLACE:

Note: Applicants are instructed to enclose self-attested copies of:

a) Educational qualifications certificates.

b) Experience certificates.

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