GOA TOURISM DEVELOPMENT CORPORATION LTD. PANAJI-GOA.

APPLICATION FORM (Candidate should not add or delete any item or carry any item to another page)
Paste Passport size photograph & put signature half on the photograph and half on the application form

Advertisement number Year

_____________________________________ B. Serial number of the post applied for ______________________________________ C. Name of the Post Applied for: _________________________ D. Application fee : Details of Indian Postal Order/Demand Draft, are as follows: Name & Branch of the Issuing post Officer Bank 1 Indian Postal Order/Demand Draft Number Date 2 3 Amount

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ALL ENTRIES IN THIS APPLICATION TO BE FILLED IN BLOCK LETTERS BY THE CANDIDATES IN THEIR OWN HAND WRITING 1.FULL NAME IN CAPITAL (First Name)

( Middle Name)

( Last Name) ___________________________________________________________________________ 2.Postal address for communication

PIN

Age as on the closing date for receipt of application ____________________________________________________________________ 6.PAGE TWO (b) Residential address (Enclose proof) PIN (c) Telephone number Res. Indicate it clearly (Tick mark) (i) Gen____________________________ (ii) SC_____________________________ (iii) ST ____________________________ (iv)OBC___________________________ (v)Physically handicapped ____________ vi) Ex-Serviceman ___________________ vii) Child of a Freedom Fighter__________ Yes No . Mobile 1. Nationality 7. (i) Date of Birth DATE MONTH YEAR (ii) Place of Birth _________________________________________________________________________ 5. Male/Female (Tick mark) M F Enclose Birth Certificate 4. Category to which the candidate belongs.

PAGE THREE 8 * Languages Known (A=Fluent. C=working) To Speak A A A A 1. Others: 1. 1. Hindi 5. 2. Konkani 3. Marathi 4. • False and misrepresentative statement/s may email in disqualification . B=Good. English B B B B C C C C To Read A B C A B C A B C A B C To write A B C A B C A B C A B C 2.

N o.Educational qualifications (full particulars starting from SSC onwards) Sr . 1 Exam Passed Name of Board/University Subjects taken for Examinatio n 4 Month and Year of passin g 5 Grade/Class / Division Percenta Subject of ge specializatio Of n Marks 7 8 2 3 6 .PAGE FOUR 9.

PAGE-FIVE 10. Course Name of the completed/ Organization/ Exam Institution passed Duration of Course Degree/Diploma From To Grade/Class/ Subject of Division/ Specialization Percentage of Marks . No.Training/Professional courses undergone after completion of School.College education(Relevant to the post applied):Sr.

Work experience:Name of Organization/ Institution/ Establishment Period(Exac t Dates to be given) Designation of the post held Nature of the Scale Total Nature appointment of Emoluments of to the office Pay drawn duties Contractual/Adif hoc/Regular/ any Temporary /Permanent 5 6 7 8 1 2 3 .PAGE – SIX 11.

(Please state clearly whether. candidate possesses the essential qualification/s and experience prescribed for the post). Has the candidate ever been Debarred or disqualified by G.Any other relevant information. Whether willing to accept the minimum starting in the scale of pay attached to If not.PAGE-SEVEN 12. in the light of entries made in previous columns. YES NO Essential qualification and Experience required for the post Essential qualification and experience possessed by the candidate 16. Qualification/required and possessed.T. the candidate wishes to furnish in support of his/her suitability to the post (attach separate sheet. What is the period of joining time required by the candidate after getting offer of appointment 14. duly signed) 15.C. what is your expectation for increments and furnish reasons for the same 13.D. or any other Department .

Description of certificate/documents 19. by the Corporation. give details (ii) 18. misrepresentative or incorrect. I understand that. No.from appearing at its examination/selections? If yes. my candidature for the post applied for is liable to be cancelled/rejected even after selection.Details of enclosures:Sr. DECLARATION: I hereby declare that all the statements made in this application are true.. correct and complete to my knowledge and belief.(i) Has the candidate ever been convicted of a criminal offence and/or imposed upon any major penalty such as dismissal/removal or compulsory retirement from service Any criminal prosecution/disciplinary action pending against the candidate? Wherever the answer is “Yes”. give details YES NO PAGE – EIGHT 17. . in the event of any information being found to be false.

PLACE: DATE: ___________________ SIGNATUE OF THE CANDIDATE NAME IN BLOCK LETTERS .

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