You are on page 1of 4
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 service er /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 ‘Signature beyhie 2/22 Fe wet a fx ag forv/adt a1 2. AS eS dad wet ES ws SASH Aa Ms VAS Ts! 3. AS <8 sfenr foror Hofer foorss devon Adt ms egAs 31 4, A fore cet Henrétors wan ad 31 5. Ae frre nofen foe cet H ferattmgnnt acest Da adit 31 6. He fre att dee an/fsas aafeans st Ye feo 31 faors aast sree ats aiet 3 fr Cas fiers aot = ees 3) det Sa aur B at Stmr for Fas cet Feo aes ust aet st fen vt fade fitedst Act watt fiers agar : Dee Refer faorss fers 2f2423 sessessscneeneeennssssesenenseeeetnnnteeeneeeed INTE vsnneerneseeenneeneneeenesssnssesassesnnseee HURT AGG sessssesssesnseenasesaseesanseeneseeeees brafer Sars frafen er weet rofen = HF Inge feo [rae few ee . a on mene Flame de a fofoa ae at [TE ae ae (Se fist aes pA senenee PART ssneene pee 2 a ASEH STS AH AG esos HAT eeseeee fess. monet 2 sAdia dist ie 3 fa AS eS Cusas wae Fae Hot = EAS TS! aera wfendt fitter mens = vrs AAS Hos

You might also like