ANNEXURE-I

RAIL VIKAS NIGAM LIMITED

Advertisement No. 19 /2023
APPLICATION FORM FOR ENGAGEMENT OF MGR/DY.MGR/AM (CIVIL), MGR/DY.MGR/AM(ELECT,) &
MGR/Dy.MGR/AM(S&T) FOR CIVIL, ELECTRICAL &S&T DEPARTMENT ON REGULAR BASIS FROM OPEN MARKET
To,

1) Applied for the Post: DEPUTY MANAGER |.CNIL.(EL).

2) Name of the Candidate (IN BLOCK LETTERS):

GAU RAv DUBEY

3) Father's Name (IN BLOCK LETTERS):

JAI SH AN K AR UBEy

4) (a) Date of Birth: 15 o

(b) Present Age (As on 01.10.2023) :
32
Years Months Days
5) Sex: Male VFemale

6) Aadhaar Number:
8 83o42o7o|S9
7) Community (UR/OBC-NCL (Non-Creamy Layer/Sc/ST/EWS) : .UK..
Religion: ..tNDU .*****w*****

9 Marital Status: .... MARRIED

Nationality: ...NDIAN
10)
Personal Marks of ldentification (To be filled compulsorily, if no such mark, write "Nil")
11)
(i) ...A..mele...on..left..3ide...o...the..n9se.:.
(61)....ark...f.sat..at.eft.fone.azn..
12) Address for Communication:
Elat..N...7o...83.TowER,...PANCHSHEELaREE NS ISeCTOR- l6B,
...4REATER..NOIDA.WEST....
.. state...ITAR...PRADES... Pin Code....2.91.306.
13) Permanent Address:
MILAGE.-.BHA4WAN PuR.ToLA.-.BHABHRA.,.PoST- BHAGWANPR.iA..
BHAVA RAR,THANA.- KHAIINL.TEHSIL-SAMJANWAN.,.G0RAKHPUR.
State UITAR.PRADESA,. Pin Code....R13401.

14) () Landline Telephone No. with STD Code:. &Mobile No...5219233929

(ii) E-mail Address: &vdubgisegmail. com
15) EducationalQualification (Self Attestedphotocopies of Educational Certificates to be attached):
Exam Passed Board/University Year of Division/ % of
Passing Class Marks
Vpto 2nd Sem. 7:5 (CG PA)
M.Undengound
TEOH (qeote NIT HA MIRPUR,H-P. Dol6-17 (NoT COMPLETE) upte 2nSemester.
8.TECH (Civil Engineering) U.PT.U.,
Lucknow Qot4 1s+ 64.72/
Intermediabe (i24) I$C Bo ARD Qo09
tigh Sehoo C1om) IcSE BOARD Qo07 19/
PS:- Please use separate sheet for more experiencde.

16) Brief Relevant Professional Experience (Self Attested photocopies of Certificates to be attached):
To Nature
Name of the Pvt/Govt/PSU Designation Grade Pay/ From
No. Organisation /Semi Govt CTC (D/M/Y) (D/M/Y) of Work
done

DMRC Ase/crviL 4,00 -1,25one oy/o/z0 Tiu DATe Desija drasig, ren
bMRC PSD JE/CIL 4o0s- 115,0s0 oY/19/20|n o3/1o/2022 Civil Constction J Mantenane
sork
3. BIT COLEGE, Pyt. Lecturer ,000 P.M. o6/oy/2015 21)07) 20| Lecturer sjes Streg u material
GoRAKHOUR, Ue. Stuch
17) Whether employed in any Central Govt./State Govt./PSUs/Semi Govt. (Yes/No ....ES..
(If yes, then application should be sent through proper channel or with NOC issued by Employer)

18) Have you ever been involved in Anti National activities?..NO.

19) Have youever been convicted?..... NO..

20) If yes, please give details:

21) List of Enclosures:

S..No. Details of Enclosures

1. Copy latest Salary slip amd Espeu'ene Centificates.
2 Edu cationalQualifications '(Deree, Marks heet,e )
3 ork Expuenie.
Gate score Cards Year- 2016, 2019 and 2020)

DECLARTION
Ihereby declare that allIn the details given by me are correct and necessary documentary proof will be produced at the time of
Screening/interaction. case any of the above mentioned details have been found to be incorrect or failure to produce
at any time. In the event of my
documentary proof in support of the same, my candidature is liable to be summarily cancelled
event of failure to abide by the same
selection, Iagree to abide by the rules & regulations of Rail Vikas Nigam Limited and in the
submitting this Application form does not give me a right to be
my candidature is liable to be cancelled. Ialso understand that
called for Screening/Interaction.

Place: NEW DELH)

Date: ojo/2029 Signáture of the Candidate