w
(e)
‘Schedule-A
Application Form
PERSONAL DETAILS:
(a) Name of the Applicant
(0) Date of bith
(6) Residence:-
() Permanent
(W) Comespondence
(@) Namo of Department/Entty in which working
{0} THRMS code (if any)
(1) Educational Quaifcations:-
(ji) On the dete of initial engagement
(i) At present
(G) Length of service inthe Depertment/Entity
(n) Any break in service:- Give detais
(0) Post against which engaged by Department/Entity
(i) Mode of engagement:-
(0 By open competitive exam, if yes
copy of result have attach
(i) By interviow
(iil) Any other means.
(k) Any FIR/Departmental Enquly/Conviction/ Trial in Court
‘Signature of Applicant
Date
Place
OFFICE DETAIL
(2) Name of the Department/Entty
(6) THRMS code of the Applicant
(€) Mode of engagement:-
() By open competive exem.
IF yes, eltach copy of result (i evalble)
(i) By interview
Gi) Any other means
(4) Length of service in Depanment/Entity
(6) Any break in serviceer /23
(0 Education quaiicaton on the date of
‘engagement whether as per the qualification
for the post mentioned in Service Rules of not.
(0) Any FIR/ Departmental Enquy/Convcin, Til in Court
‘Signaturebeyhie
2/22
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