ON-LINE APPLICATION FOR RECRUITMENT OF SPECIALIST OFFICERS

Please check Print Preview in A4 size Portrait format with 0.25" margin from all sides (Click to Print) 21034 Registration # : 110865

Full name:

Madhavendra Ambadas Wankhade

Post : Post Code : Category : If physically challenged : Type of Disability : Percentage of Disability : Do you intend to use the services of a scribe (only for VI and OC both hands affected by cerebral palsy)? : Whether domiciled in Kashmir Division of the State of J&K during the period 1-1-1980 to 31-12-1989? : Whether you belong to Religious Minority Community ? : Religion to which you belong : Are you an Ex - Serviceman ? : Date of Discharge : Period of Service (In Months) : Officers Serving in Regional Rural Banks and who have

IT Officer JMG Scale I 01 OBC NO NA NO NO -NO --NO

minimum 5 years of service ? : Are you a Clerical Employee of Central Bank of India ? : Nationality : Centre of Examination (if Exam is held) : Centre code : Application Fee / Postal Charges Details : Journal No : Branch Name : Branch Code No. : Deposit Date : Amount : Personal Details : Date of Birth : Age completed as on 31.08.2011 : Birth Place : Birth District : Birth State : Gender : Marital Status : Father's Name / Husband's Name : Mother's name : Address for Correspondence : District : State : Pin : Permanent Address : District : State : Pin : Contact Details: Phone No : Mobile No: Email ID : Qualification Details (as on 31.08.2011): Exam Passed Subject /Stream

NO indian Hyderabad 19 574875704 begumpet 3877 02-12-2011 500

23-08-1983 28 amravati amravati MAHARASHTRA MALE Unmarried ambadas kashirao wankhade rajani ambadas wankhade C/o Ak Wankhade Dr Pdmc Road Saurabh 2 Kantanagar Amravati Amravati MAHARASHTRA 444602 C/o Ak Wankhade Dr Pdmc Road Saurabh 2 Kantanagar Amravati Amravati MAHARASHTRA 444602 0721-2664109 8121657271 madhav.wankhade@gmail.com Year of Passing % of Marks Class / Grade

Graduation : Post Graduation :

Degree in Electronics and Telecommunications Others-cdac

2007 2008

57.38 55.00

Second Class Second Class

Are you Certified Associate of the Indian Institute of Bankers NO (CAIIB) : Post Qualification work experience details if any as on 31.08.2011 (Start from present Employer) : Name of the Employer & Nature of Employment tata teleservices Designation and Rank if any network operations From(mm/yyyy) To(mm/yyyy) Nature of Duties Performed operations Reason for Leaving Years of Service (YY/MM) 1/3

02/2009

05/2010

contract

Total Relevant Experience (in months) : 15 Do you have 2 years experience of translation in a full time post in any organization : Do you have 5 Years experience of practice at Bar OR Judicial Service and /or Law officer in Legal Dept. of a reputed Bank or Central/State NO Govt. or of a Public Sector Undertaking with practice at Bar for a minimum period of three years : Other Details : Languages Known Marathi Hindi English
DECLARATION:
I hereby certify that the above information furnished is correct to the best of my knowledge and belief. I have not suppressed any material fact or factual information in the above statement. I am aware that in case I have given wrong information or suppressed any material fact or factual information or I do not satisfy the eligibility criteria according to the advertisement, then my candidature will be rejected/services terminated even after permanent employment without giving any notice or reasons thereof. I hereby certify that I am satisfying the eligibility criteria for the post applied for in terms of the advised criteria in respect of age, educational qualification and experience etc. I am also willing to serve anywhere in India. I agree that the Bank has the right to transfer me to any part of the country and/or to any job position at its sole discretion in terms of applicable staff rules from time to time. I hereby agree that any legal proceeding in respect of any matter or claims or disputes arising out of application or out of said advertisement can be instituted by me only at Mumbai and Courts/Tribunal/ Forums at Mumbai only, shall have sole and exclusive jurisdiction to try any cause/dispute. I undertake to abide by all the terms and conditions in the advertisement given by the Bank.

Read Write YES YES YES YES YES YES

Speak YES YES YES

Place: Date: 02-12-2011 Signature of Applicant

Madhavendra Ambadas Wankhade

Please retain your Registration No. and Password emailed to you carefully for further reference