Application Form Affix a recent

Passport size
1. Name of the Applicant : …………………………………… photo
(in full & Block Capital Letters)

2. Fathers/ Husband Name : ……………………………………

3. Address for communication : ……………………………………

Including PIN Code, Mobile ……………………………………
Number & Email id ……………………………………
……………………………………
……………………………………

4. District Applied for : ……………………………………

5. Date of Birth (DD-MM-YYYY) : ……………………………………

(Enclose Copy of Birth Certificate/
Certificate of HSLC examination)

6. Age as on 31-07-2020 : ……………………………………

7. Sex (please tick) : Male/ Female/ Transgender

8. Academic Qualification from HSLC onwards :

(Enclose supporting documents)
Sl. Name of the Exam Name of Board/ Year of Stream % of Marks
No. Passed Council/ Passing
University

9. Qualification in Computer :
(Enclose supporting document)
Sl. Name of Course Duration Whether Degree/ Institute
No. Diploma/ Certificate

10. Work Experience :

Sl. Name of the Designation Job Period
No. organization responsibility From To
(in brief) (DD-MM-YY) (DD-MM-YY)

11. Device Owned (Smartphone/ Tablet/ Laptop) : …………………………

12. Do you have a two wheeler (Please Tock) : (Yes/ No)

13. If “Yes”
a. Vehicle Number : …………………………
b. Make : …………………………
c. Driving Licensee Number & Date of Expiry : …………………………
…………………………
Declaration :
I, do hereby declare that the information furnished above are true to the best of my
knowledge & belief.
I, further declare that I am aware that the recruitment will be for a period of 30 (thirty)
working days on purely temporary basis.

Date:-
Place:- ……………………………
(Signature of the Candidate)