Department: LABOUR AND EMPLOYMENT

APPLICATION FOR NEW ENROLLMENT

( )
(*Marked Fields are mandatory)
(*চিহ্নযু ক্ত তথ্যব োৰ োধ্যতোমূ লক)

Applicant’s Details (আবেদনকাৰীৰ বেৱৰণ)

*Applicant’s Name (আব দনকোৰীৰ নোম) ………………………………………..
*Applicant’s Gender ( ) Male Female
*Mobile Number (ম োইল নম্বৰ ) ………………………………………..
Father’s Name ( ) ………………………………………..
Date Of Birth ( ) ………………………………………..
Religion ( ) ………………………………………..
Caste ( ) ………………………………………..
Eye Sight( ) ………………………………………..
Height ( ) ………………………………………..
Weight (ওজন ) ………………………………………..
Recommended occupation ( ) ………………………………………..
Alternative occupation ( ) ………………………………………..

Other Details ( )
Mail Id ( ) ………………………………………..
Pan Number ( ) ………………………………………..
Aadhar card Number ( ) ………………………………………..
Qualification ( ) ………………………………………..
Grade ( ) ………………………………………..
Institution ( ) ………………………………………..
Date of Registration ( ) ………………………………………..
Prominent Identification Mark ( ) ……………………………….
Employment Exchange Name ( ) ………………………………….

Date: …………………………. Signature of the applicant

Place: …………………………. (আব দনকোৰীৰ িোক্ষৰ)

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 Department: LABOUR AND EMPLOYMENT
APPLICATION FOR NEW ENROLLMENT
( )

Address Details ( )
*State (ৰোজ্য) ………………………….
*District(চজ্লো) ………………………….
*Sub-Division (মহকুমো) …………………………..
*Circle Office(ৰোজ্হ িক্র) ………………………….
Postal Address ………………………….
Temporary Address ………………………….

Supporting Documents (সংলগ্ন নচথ্)

1. *Proof of Residence in Assam for a period of 20-25 years.
2. Age proof certificate (Birth Certificate/ HSLC Admit Card/ School Certificate etc.)
3. *Educational Qualification Certificate (Mandatory)
4. Additional Qualification Certificate etc.
5. Experience Certificate (if any)
6. Caste Certificate
7. *Self-attested passport sized photograph
8. NOC from current employer (in case if employed)
9. Original I-Card issued by the competent authority
10. Any Other Document.

Date: …………………………. Signature of the applicant

Place: …………………………. (আব দনকোৰীৰ িোক্ষৰ)

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