APPLICATION FORMAT (To be submitted in A4 size paper)

1. POST APPLIED FOR :

2. Name of the applicant : Affix passport

(in capital letters) size
3. Date of Birth : photograph
Day Month Year duly signed by
4. Gender - Please tick ( √) :Male Female the candidate
5. i) Caste/Category - Please tick (√) :General OBC SC ST
Caste/Community Certificate should ( Non Creamy Layer)
be attached

ii) Religion :

iii) Whether Physically Challenged Yes No

Please tick (√)
If yes, type & percentage of Disability: Locomotor Hearing impaired
Disability Percentage:_______% Decibels : __________

6. Postal address :
:
:
:
7. Academic & Professional Qualification :

Examination Name of University Specialization Year of Marks % of

Passed Course / State passing obtained marks
SSC
Intermediate
Degree
PG Degree
Diploma

8. Experience:

Name of Period Nature of organization Work experience

organization &
Address From To

9. Bank Demand Draft:No: Amount Rs. Dt: Bank:

10. Telephone Nos. 11. E-mail address :

!2. Languages Known: 13. Mother Tongue:
DECLARATION

I hereby declare that all statements as mentioned in this application are true, complete and
correct to the best of my knowledge and belief. I understand that in the event of any
particulars or information given above being found false or incorrect, or if at any stage it is
found that I do not possess the prescribed qualification for the post, my candidature will be
rejected ab-initio and I will not have any right/claim to the post.

Date: Signature