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Of India & Govt. of U.P) (A MINI RATNA COMPANY) Affix recent Passport Size Photograph 1 | Name of the Candidate (As per High school Certificate) a Apprentice Category (Graduate Apprentice/ Technician Apprentice (Diploma) 3 | Branch (As per Advertisement) 4 Registration/ Enrollment No. as Indicated in Web Portal — www.nats.education.gov.in 5 Aadhar No. of Candidate 6 Father's Name 7 Date of Birth 8 ‘Age as on closing date (15.03.2024) 9 Gender (Male/ Female) 10. | Marital Status 11 | Category (Gen/SC/sT/oBc/Ews) 12 | Are you physically handicapped (Yes/No /?) If Yes please mention the details as Follows ‘Type of handicapped: (VH/HH/OH) Extent of disability as specified in the disability certificate : 13 | State of Domicile 14 | Contact No. - 15 | Email id. 16 | Postal Address/ Pin Code -7 Permanent Address/Pin Code 1B Currently are you taking any apprenticeship training or have you undergone apprenticeship training earlier? Yes/No 19 Have you any work experience one year or more than ? Yes/No 20. Educational Qualification : Sl | Beam Board/institute/ | Discipline? | Duration | Month& | Maximum | Marks | Percentage No | Passed | University Subjects ofstudy | Yearof | Marks | Secured | of Marks # = Boe Passing a | wsc/io™ 2 [ae 3._| DIPLOMA BE/B.Tech Declaration : Ifis any Cumulative Grade Average (CGPA/ Please convert it to % of Marks) and enclose conversion certificate. | affirm that the information given in this application is true and correct to the best of my knowledge and belief. | further undertake that if at any stage it is discovered that an attempt has been made by me, will fully to conceal or misrepresent the facts, my candidature/ appointment shall be summarily rejected or terminated without any notice. Date: Enclosure ‘Signature of the CandidateFO) “ATE TO BE PRODUCED B BACKWARD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA This is to certify that Shri/Smt/Kumari son/daughter of iH ___ of villageftown in DistricyDivision _ ____ in the State/Union Territo belongs to the Bi _community which is recognised as a backward class under the Goverament of India, Ministry of Social Justice and Empowerment’s Resolution No, dated __*. Shri/Smt/Kumari and/or histher family ordinarily reside(s) in the _ ____ DistricvDivision of the State/Union Territory. This is also to certify that he/she does not belong to the persons/sections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India, Department of Personnel & Training O.M. No. 36012/22/93 - Estt(SCT) dated 8.9.1993**. District Magistrate Deputy Commissioner etc. Dated: Seal +. The authority issuing the certificate may have to mention the details of Resolution of Government of India, in which the caste of the candidate is mentioned as OBC. **., As amended from time to time. Note:- The term “Ordinarily” used here will have the same meaning as in Section 20 of the Representation of the People Act, 1950. 5OBC Undertaking Declaration/undertaking - for OBC Candidates only I, son/daughter of Shri resident of village/town/city district State hereby declare that | belong to the community which is recognized as a backward class by the Government of India for the purpose of reservation in services as per orders contained in Department of Personnel and Training Office Memorandum No.36012/22/93- Estt. (SCT), dated 8/9/1993. It is also declared that | do not belong to persons/sections (Creamy Layer) mentioned in Column 3 of the Schedule to the above referred Office Memorandum, dated 8/9/1993, which is modified vide Department of Personnel and Training Office Memorandum No.36033/3/2004 Estt.(Res.) dated 9/3/2004. | also declare that the condition of status/annual income for creamy layer of my parents/guardian is within prescribed limits as on financial year ending on March 31, 2016 Signature of the Candidate Declaration/undertaking not signed by Candidate will be rejected