Affix recent passport

size colour
photograph signed
BHARAT ELECTRONICS LIMITED by the candidate.
Jalahalli Post, Bengaluru – 560 013 Do not use stapler or
pin.

1. Name of the Post applied for : ……...………………………………………………………………

2. Name of the candidate in full :…………………………………………………............................

(As per 10th Class Certificate)

3. Father’s/ Husband’s Name : …………………………………………………………….

4. Date of birth : ………………………………… 5. Age (as on 01.01.2023) : …………………….

6. Gender : ………………………………………. 7. Marital Status : …………………………

8. Nationality : ………………………………….... 9. Religion …………………..………………

10. Do you belong to UR/SC/ST/EWS/OBC : …………………………………………….…

11. Are you a person with disability : Yes / No

If yes type of disability (OH/HH/VH) : …………….. Percentage of disability………

12. SBI Collect reference Number: …………………………………………

13. Mobile No : ………………………….. Email : ………………………………………………

14. Are You Ex-serviceman : Yes/No

15. QUALIFICATION (From 10th Class Onwards):

Percentage / Year of
Qualification Institute/ University Discipline
Class secured passing

10th Class

12th Class

MBBS

MD

Others
16. EXPERIENCE DETAILS (Start with the Existing):
Please attach a separate sheet giving a brief about your duties & responsibilities handled by you.

Service details No of Years

Name of the (Period) of Salary Area / Departments
Hospital Experience Drawn worked in
From To (YYMM)

17. Are you presently working in a Government/Quasi//PSU/Private: Yes /No

18. If Yes, are you employed on permanent / contract basis : ………………………………………

19. Please give particulars of your relative/s employed in BEL, if any:

Name Designation Department Unit Relationship

20. Address:
PERMANENT CORRESPONDENCE

PH.NO. PH.NO:
Email address : Email address:
Email address to be written in Capital letters and specify in writing if zero ‘0’ or alphabet ‘O’ is in
part of your email id.
21. List of photocopies/documents enclosed:
a) 10th Standard marks card (as proof of date of birth)
b) MBBS/MD Degree certificate (as applicable)
c) Caste /Tribe/ Community/ Disability certificate in case of candidates belonging to
SC/ST/OBC/PwBD respectively.
d) Candidates claiming reservation under any of the above categories are required to submit the
certificate in the prescribed format. The formats of various certificates are provided as link to
the advertisement. Candidates belonging to OBC category should produce the certificate
issued on or after 01.01.2022.
e) Post qualification work experience certificate/s from previous/current employer. Where
current employment certificate is not produced, the Offer of current appointment, Employee
ID proof and latest pay slip should be compulsorily enclosed.
f) Candidates working in PSUs/Govt. organizations should compulsorily submit the application
through proper channel or produce ‘No Objection Certificate’ at the time of the interview.
g) Discharge certificate in case of Ex-Servicemen.
h) Print of the payment receipt.

UNDERTAKING

I affirm that the information given above is true and correct. I further undertake that, if at any
stage, it is discovered that an attempt has been made by me to willfully conceal or misrepresent the
facts stated above, my candidature may be summarily rejected or my employment terminated.

SIGNATURE OF THE CANDIDATE

Date:
Place :