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Bharatiya Reserve Bank Note Mudran Private Limited

Application for the post of Assistant Manager /Industrial Workman Grade I (Trainee)
(NOTE: The candidates must fill the application in his / her own hand in English /
Hindi and should use, as far as possible, only international form of Indian numerals)

Affix recent
Passport size
Name of the Post applied for: ____________________________ photograph
here and sign

1. Centre for Written Examination: _________________________

2. Name (in BLOCK LETTERS) as appearing in SSLC / SSC / Matriculation

(Write one letter per box, leaving one box blank between two parts of your name/

3. Gender: Male Female

4. (a) Address for communication (in BLOCK LETTERS). Name not to be



(Write one letter per box, leaving one box blank between two words)

(b) Email:________________________________________________________
(c) Telephone No.(with STD code) ______________________________
(d) Mobile No. : _____________________________________________

5. Indicate the category to which you belong by putting a (√) mark in the
appropriate box:


6. Father's/Husband's Name: _____________________________________________

7. (a) Are you an Ex-Serviceman? Yes No
If yes, Date of enrolment ________
Date of Discharge ____________

(b) Are you Orthopaedically Handicapped? Yes No

(c) Are you Hearing Impaired? Yes No

(d) Are you a candidate who had ordinarily

been domiciled in Kashmir Division
of State of Jammu & Kashmir during
the period 1.1.1980 to 31.12.1989 ? Yes No

8. Nationality: _______________

9. Date of Birth (As per School Leaving Certificate-SSLC / SSC / Matriculation)

Date Month Year

10. (Only for SC/ST/OH/HI)

(a) Are you interested in pre-examination Training? Yes No

(b) If Yes, Indicate the centre: Bangalore Kolkata

Mumbai New Delhi

(c) Medium of Pre-examination Training: English Hindi

11. Place & State of Domicile: __________________

12. Particulars of Bank’s Pay Order / Demand Draft

Name of the issuing Bank Date of Issue Pay Order/ DD Number Amount (Rs)

13. Please indicate your branch/group as applicable (For the post of Assistant Manager only)

i) Mechanical ii) Accounts

iii) Electrical / Electronics / Printing / Pulp & Paper Technology

14. Educational Qualifications (As on 30th April 2011). [Use separate sheet, if
required, duly signed]
Name of the Examination passed Year of % of marks
University/Board with Division / Class / passing (Aggregated
/Institute Grade upto 2 decimals)

15. Experience (as on 30th April 2011) [Use separate sheet, if required, duly signed]

Name/s with full Date Experience Designation/ Last Gross

address/es of post held Salary drawn
From To Years Months

I hereby declare that all statements made by me in this application are true, complete
and correct to the best of my knowledge and belief. I understand that in the event of
any information being found false or incorrect or suppressed or I do not satisfy the
eligibility criteria, my candidature/ appointment, at any stage, is liable to be cancelled/
terminated. I am willing to serve anywhere in India. I hereby, agree that any legal
proceedings in respect of any matter or claim or dispute arising out of this application
and/or out of the said advertisement can be instituted by me only at Bangalore, and
courts/tribunal/forums at Bangalore only shall have the sole and exclusive jurisdiction
to try the case/dispute. I undertake to abide by all the terms and conditions mentioned
in the Advertisement No.1/2011 issued by the Company.


Date: (Signature of the candidate)