Government of India Bhabha Atomic Research Centre Application for the post of Upper Division Clerk/Stenographer Grade - III

Advertisement No.1/2011-R-III

Last date for receipt of Application:16.09.2011

Fix a recent colour Passport size photograph here

1 Name in full (in block letters) (As per SSC/SSLC certificate) Shri/Smt/Kum 2 3 4 Nationality Religion Date of Birth (in Christian era) : : :

5 6 7

Sex Marital Status (i) Caste

(Put X in the box which is applicable) (ii) Indicate the name of Caste/Tribe/Community

Male : : SC ST Single Married

Female Widow Widower

OBC

GEN

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Are you domiciled in Jammu & Kashmir during the period from 01/01/1980 to 31/12/1989? Are you a family member of those who died in 1984 riots? Whether belongs to Minority Community?
[Muslim/Christian/Sikh/Any other (Please specify)]

: YES : YES : YES : OH VH HH NO NO NO

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Type of Physical Disability ? Percentage of Disability (as certified by the Competent Medical Authority in the PH Certificate)

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Status (i) Typing Speed (English) (ii) Shorthand Speed (English) (iii) Do you possess a shorthand/typing speed certificate from Govt. Institute or Institutes recognized by Government? Correspondence Address with Pin Code

: :

Ex-SM

Deptl

Others

___________________wpm (For Cat.No. 1&:2) __________________ wpm (For Cat.No.2) YES NO

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Permanent Address with Pin Code

Tel. : E-mail :

Tel :

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Educational & Technical Qualification Examinati on Passed

SSC/SSLC

: Year of passing Details of Marks Marks Aggregate obtained Percentage

Board/ University

Subject

Maximum Marks

Knolwedge of Computers: Yes

No MS Outlook Database

If Yes, Please indicate field of knowledge: MS Office 16

Indicate the course of study, if any, the applicant is continuing presently: Course University/ Board/Institution Full Time/ Part Time Duration of the Course

17.

Experience (Particulars of all previous and present employment are to be furnished) Name & address of employer Post held Whether Central or a State Govt. or Public Sector Undertaking / Autonomous bodies / Private Period of Service Permanent or Temporary Reasons for leaving

From

To

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Languages known : Language

Speak

Read

Write

19.

Are you under any contractual obligations to serve the Central/State Government/any other Public Sector Undertaking/Autonomous Bodies? If so, please furnish full details.

20

Are you in receipt of any pension, gratuity or employers share of contribution of Provident Fund from Central / State Govt. or any Public Sector Undertaking? If so please give particulars thereof.

21

Details of relatives already employed in Department of Atomic Energy or its Constituent Units : Name of relative Relationship Unit in which employed Post Held

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Any other information

Declaration
I hereby declare that the above information is factually correct to the best of my knowledge. I also understand that I will be disqualified if any of the information furnished by me is found to be incorrect. Signature of the candidate Place: ________________ Date: ________________