(A 'Navratna' Govt. of India Enterprise) P.O. NEYVELI-607801, Cuddalore District, Tamil Nadu Regd. Office:135 Periyar EVR High Road, Kilpauk, Chennai-600 010)

Registration-Cum-Application Form Registration No. Post Applied Discipline Area Pay Band / Grade : 33521 - 1 : Dy. Executive Engineer : Mechanical : Thermal : 24900-3%-50500 (E-3)
Affix recent Colour Photograph of the Candidate

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: 06/2011

Preferences of Location : 1. Barsingsar Project(Rajasthan)

Candidate Name Father's Name Communication Address

: Madan Yadav : Shri Raj Kumar Yadav : GF-15 KAPASAN ROAD : ZINC NAGAR CHITTOR GARH Taluk / Mandal : District State Pincode : CHITTORGARH : Rajasthan : 312001 : 9799298589

Contact Number E-mail ID Date of Birth Community Religion EX-Serviceman Person With Disabilities

: Landline : Mobile : : 01-JUL-1983 : UR : HINDU : No : No Sub Caste :

Qualification Particulars Name of the Degree/Diploma Course Duration (in years) Month/Year of Passing Name of the Board/Institute/University Marks(in %) /Class /Grade 72.4

Degree in 4 Years 5/2006 UTTAR PRADESH Engineering(Mechanical) * TECHNICAL UNIVERSITY * indicates primary qualification selected for the post applied

Experience Particulars Post Held : 1 Organisation Name From Date Nature of Employment Pay Scale & Grade / CTC : ASSOCIATE MANAGER : HINDUSTAN ZINC LIMITED : 05-OCT-2006 : Regular : 6 LACS To Date : 22-OCT-2011 Organisation Type : Private

Registration No. 33521 - 1

Page 1 of 3

provide details of related employee Have you been a candidate for any other post in NLC during the last one Year ? If so. &#61504. &#61504. within 7 days of such change. Chennai-600 010) Basic Nature of Duties : &#61504.Developing the vendor and interacting with them on a regular basis.NEYVELI LIGNITE CORPORATION LIMITED (A 'Navratna' Govt. furnish details Is any case pending against you ? If yes. furnish details Are you related to any employee of NLC ? If yes.Working as safety steward. 0 Months. &#61504.Responsible for maintaining 5S into the designated Areas. and utilities. Office:135 Periyar EVR High Road. NEYVELI-607801. furnish details Whether you have served in NLC in the past in any post ? : No : No : No : No : No Application Fee Particulars Mode of Payment Demand Draft Number Date of Issue Name of Issuing Bank Name of Issuing Branch Name of the Payable Branch Demand Draft 561246 11-11-2011 STATE BANK OF INDIA CHITTORGARH STATE BANK OF INDIA NEYVELI Declaration I hereby declare that all the above information furnished by me are true and complete. Cuddalore District.O. Total Relevant Experience (Post Qualification Experience) 5 Years. at any stage.Ensuring that the workforce carries on their tasks in a healthy and safe environment. modifications in the process.1 Page 2 of 3 .Responsible for overall maintenance of roaster acid. 18 Days Languages Known Details Language Hindi English Read Yes Yes Write Yes Yes Speak Yes Yes Have you ever been convicted / detained / Prosecuted / arrested / bound down / debarred / fine by court of Law ? If yes. if appointed to the post applied.Carrying out quality checks of spare parts.Managing the spare parts and ensuring significant improvement. Kilpauk. 33521 . &#61504. I also undertake to notify any changes in the information furnished. &#61504. Tamil Nadu Regd. I am aware that furnishing of false / incomplete information will result in rejection of my candidatute /loss of employment. &#61504. of India Enterprise) P. Registration No.

Disability Certificate. i. Caste / Community Certificate (Applicable for SC/ST/OBC Candidates). Latest Pay Slip Copy.O. if applicable. Chennai-600 010) Place : Date : SIGNATURE OF THE APPLICANT ATTACHMENTS 1. if applicable. Discharge Certificate for Ex-Servicemen. NEYVELI-607801. Attested copies of the following Documents / Certficates in proper and valid formats. Registration No. Registration Certificate with Medical Council of India /State Medical Council. of India Enterprise) P. NOTE : (a) Please do not send any original certificates along with the Registration-Cum-Application Form. 33521 .1 Page 3 of 3 . d. 2.NEYVELI LIGNITE CORPORATION LIMITED (A 'Navratna' Govt. j. Qualification (Provisional /Degree Certificates and Consolidated / Semester-wise mark Stetements. are to be enclosed a. in support of Qualification ). Original Certificates are to be produced at the time of Interview. g. Tamil Nadu Regd. in original. if applicable./Quasi Govt. NLC's copy of the Bank Challan / Demand Draft (Whichever applicable). h. e. b. Cuddalore District. First Class (For E-7 Grade) / Second Class(For E-3 Grade) Mine Manager Certificate of Competency Under CMR 1975. should forward their Registration-Cum-Application Form (obtained ONLINE) through Proper Channel or should produce NOC at the time of Interview. Experience Certificates. if applicable. f. c. Date of Birth (Birth Certificate (or) SSLC / Matriculation Mark List). Kilpauk. Self certified translated copy of the SC/ST/OBC/Disability certificate either in English or Hindi. k. from the present / previous employer(s). (b) Candidates from PSE/Govt. Mine Surveyor Cerificate of Competency under CMR 1957. if applicable. Office:135 Periyar EVR High Road.

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