TO

AFFIX PASS SIZE PHOTO GRAPH

PORT

GENERAL MANAGER (HRD) CENTRAL BANK OF INDIA, MUMBAI Dear Sir.. APPLICATION FOR THE POST OF SUB-STAFF / SUB-STAFF CUM SAFAI KARMACHARY I hereby apply for the post of SUB-STAFF/SUB-STAFF CUM SAFAI KARMACHARY in your organization. If appointed I am willing to serve the Bank at any of its offices. I agree to conform to the terms and conditions of service laid down by the Bank and to the rules, regulations and instructions in force in the Bank from time to time. I give below my personal data: PLACE: DATE: (Applicants signature) PLEASE NOTE: Applicant to complete application in his/her own handwriting neatly and legibly: If the space provided for is found insufficient a separate sheet may be attached Yours faithfully,

PERSONAL DATA 1. FULL NAME (WRITE IN BLOCK LETTERS) _______________ _________________ (SURNAME) FATHER/HUSBAND NAME 2. DATE OF BIRTH __________________________________(DD/MM/YYYY)________________________________ 1 a)FULL NAME (WRITE IN BLOCK LETTERS b) FATHERS/SPOUSES NAME a)DATE OF BIRTH DD b)PLACE OF BIRTH c) AGE AS ON 31.10.2012 MM YYYY _________ _______________ _________ SURNAME NAME ______ (NAME)

__________________________________

a)CATEGORY b)RELIGION c)EX-SERVICE MEN (EX-S) DEPENDANT OF SERVICE PERSONNEL KILLED IN ACTION (DSPKA) DISABLED EXSERVICEMEN(D.EX-S) d)PHYSICALLY CHALLENGED

SC/ST/OBC/GEN (SC/ST/OBC CANDIDATES TO ENCLOSE CASTE CERTIFICATE)

EX-S _____DSPKA________E.EX-S_____________ (GIVE DETAILS ON SEPARATE SHEET)

FULL ADDRESS: a) Local/present address

b) HOME/PERMANENT ADDRESS

NATIVE PLACE ADDRESS INCLUDING STATE

PLACE OF DOMICILE

PLACE

SINCE WHEN

Y 8 PHYSICAL PARTICULARS HEIGH T SINGL E KGS. WEIGH T CMS BLOOD GROUP

Y RH

Y V E

MARITAL STATUS (TICK APPROPRIATE BOX)

MARRIED

WIDOW/ WIDOWER

1 0

NO. OF DEPENDENTS: TICK APPROPRIATE BOX

IF MARRIED, WHETHER YOUR SPOUSE IS WORKING ? IF YES, GIVE DETAILS : IN WHICH ORGANISATION SPOUSE IS WORKING? DATE OF JOINING AND LENGTH OF SERVICE ETC., WIFE HUSBAN FATHE MOTHE CHILD OTHER TOTAL D R R REN S NO.

CHILDREN AGE 1 1

1.

2.

3.

4.

HAVE YOU EVER BEEN DECLARED INSOLVENT AND/OR HAS BEEN CONVICTED BY COURT FOR ANY OFFENCE OR MORAL TURPITUDE AND/OR ANY CASE PENDING AGAINST YOU IN ANY COURT AND/OR HAVE YOU EVER BEEN DECLARED/DISCQUALIFIED BY ANY INSTITUTION FROM APPEARING AT ITS EXAMINATION/SELECTION OR DEBARRED IN ANY MANNER FROM ANY EXAMINATION, RUSTICATED BY ANY UNIVERSITY OR ANY OTHER EDUCATIONAL INSTITUTION/AUTHORITY? IF SO, GIVE DETAILS. EDUCATIONAL QUALIFICATION: PARTICULARS OF EXAMINATIONS PASSED (BEGINNING WITH VIII STANDARD OR ITS EQUIVALENT)
EXAMINATION PASSED PRINCIPA L SUBJECT S BOARD/ UNIVERSIT Y MEDIUM OF EDUCATIO N YEAR OF PASSING NO.OF ATTEMPTS % OF MARKS CLASS OBTAINED

1 2

1 3

1 4

HAVE YOU TAKEN PART IN SPORTS/EXTRA CURRICULAR ACTIVITIES? IF SO, GIVE DETAILS TOGETHER WITH PARTICULARS OF PRIZES, CITATIONS ETC., IF ANY, AWARDED. FURNISH ON A SEPARATE SHEET, IF NECESSARY. DO YOU KNOW (TICK IN THE BOX WHICH IS APPLICABLE TYPING: ENGLISH HINDI SHORTHAND ENGLISH YES YES YES NO NO NO YES SPEE D SPEE D SPEED SPEED NO W.P. M W.P. M W.P.M. W.P.M.

1 5

1 6

HINDI YES NO COMPUTER YES OR NO: KNOWLEDGE IF YES GIVE DETAILS ANY OTHER SPECIALISED WORKING KNOWLEDGE LANGUAGES KNOWN: TO SPEAK TO READ TO WRITE MOTHER TOUNGUE WORK EXPERIENCE NAME AND JOINING LEAVING ADDRESS DATE DATE OF EXMPLOYE R b)Have you at any time during your

POSITION HELD

LAST SALARY

REASONS FOR LEAVING

previous employment been chargesheeted, suspended or have any disciplinary proceedings instituted against you? If so, give full particulars. c)Discharged or asked to resign by a former employer? d)If your time since leaving the school/college is not fully accounted for by the replies given above, account for the remainder with you. 1 7 FAMILY BACKGROUND a) FATHERS/SPOUSE PARTICULARS NAME AGE OCCUPATION FULL ADDRESS:

b) PARTICULARS OF BROTHERS/SISTERS BROTHERS/SIST AGE EDUCATION ERS NAME

PRESENT OCCUPATION

ADDRESS

1 8

1 9 2 0 2 1

2 2

ARE YOU ENGAGED IN ANY TRADE, BUSINESS, OR PROFESSION?(GIVE DETAILS) (NOTE:- BANK EMPLOYEES ARE NOT ALLOWED TO ENGAGE THEMSELVED IN ANY TRADE, BUSINESS, PROFESSION OR CALLING WITHOU THE WRITTEN PERMISSION OF THE MANAGEMENT) HAVE YOU ANY OTHER SOURCE OF INCOME? (GIVE DETAILS) ARE YOU RELATED TO ANY EMPLOYEE OR DIRECTOR OF THE BANK? IF SO, PLEASE STATE THE NAME, RELATIONSIP AND PLACE OF POSTING a)HAVE YOU EVER SUFFERRED FROM ANY SERIOUS ILLNESS? IF SO, GIVE DETAILS OF ILLNESS AND TREATMENT TAKEN b)DO YOU PRESENTLY SUFFER FROM ANY DISABILITY, PHYSICAL OR MENTAL? IF SO, STATE BRIEFLY TDHE NATURE OF DISABILITY. ADDITIONAL REMARKS IF ANY:

PERSONAL REFERENCE 2 Give names of two references who have a special standing, acceptable to the Bank, other 3 than relatives or former employers. References should have known you for at least 3 years. (i) NAME OCCUPATION ADDRESS

(ii )

NAME OCCUPATION ADDRESS

I HEREBY DECLARE THAT THE ANSWERS GIVEN AND THE STATEMENTS MADE BY ME ABOVE ARE TRUE AND CORRECT AND THAT I HAVE NOT OMITTED ANY FACT THAT I SHOULD HAVE BROUGHT TO YOUR NOTICE BEFORE MY EMPLOYEMENT, I AGREE THAT EVEN AFTER MY APPOINTMENT (IF MADE) I SHALL BE LIABLE TO BE DISCHARGED FROM THE SERVICE OF THE BANK, IF AT ANY TIME HERE AFTER IT IS FOUND THAT I HAVE FURNISHED INCORRECT OR FALSE INFORMATION OR HAVE SUPPRESSED ANY INFORMATION FROM THE BANK.

Enclosures:COPIES OF ALL CERTIFICATED DULY ATTESTED BY GAZETTED OFFICER DULY NOTARISED WHEREVER NECESSARY

Applicants Signature