इलेक्ट्रोनिक्स कार्पोरे शि ऑफ़ इं निया नलनिटे ि

ELECTRONICS CORPORATION OF INDIA LIMITED

[ भारत सरकार का (र्पररिाणु उर्ाा निभाग) उर्पक्रि ]
[A Govt. of India (Dept. of Atomic Energy) Enterprise]
कानिाक िगा / Personnel Group | भती अिुभाग / Recruitment Section

Application Form for Fixed Term Employment

Advertisement No. Name of the Post Place of posting

Applicant Name (in capital letters): __________________________

Please affix a
Mother’s Name : __________________________ recent passport
size self-
Father’s Name : __________________________ attested color
Date of birth & Age : __________________________ photograph

(Kindly furnish above details as per SSC/10th Certificate)

Gender (M/F): ___________________ Category (Gen/OBC/SC/ST/EWS): ___________________

Nationality: ____________ Religion: ____________ Other Cat. (Ex-SM/PwD) _______________
Contact Number: ____________________ E-mail ID: ___________________________________
Address for correspondence: ________________________________________________________

Qualification details:
Qualification Board / University Discipline / Branch % of marks Year of pass
B.Tech/B.Sc./B.Com
Inter/Dipl./ITI/12th
SSC/10th

Work experience details (in chronological order):

Period Reason for
Name of the Org. Post held Nature of work Salary/month
From To leaving

Professional references (Name, contact number & address):

1. ________________________ 2. ________________________

__________________________ __________________________
Declaration by the candidate
I certify that the above information is correct and true to the best of my knowledge and belief. In the event of any information
being found false or incorrect, action can be taken against me. Further, I declare that I have never been arrested/prosecuted and
convicted by a Criminal Court or involved in any other case registered by the police. I am also aware of the fact that this
assignment is purely on contractual basis and I will not raise any issue for regular employment in ECIL.

Date:
Place: (Signature of the candidate)