APPLICATION FORMAT FOR VACANCIES IN POWERGRID, EASTERN REGION-1

(READ DETAIL ADVT. CAREFULLY BEFORE FILLING UP THE FORM. USE CAPITAL LETTERS ONLY)
(DON’T ATTACH ANY DOCUMENTS EXCEPT CASTE / PH/ EX-SM CERTIFICATE & DECLARATION AND /OR DD)
(To be sent by Ordinary Post only) Affix self-attested

APLLICATION NO.(FOR OFFICIAL USE) latest Passport size

1 APPLICATION FOR THE POST OF POST CODE

Photographh

2 NAME

3 FATHER/HUSBAND'S NAME

4 ADDRESS FOR A T-
COMMUNICATION

P O-

D I S T-

State : Pin Code

Contact No. E-Mail

5 STATE OF DOMICILE 6 SEX(MALE/FEMALE) M/F

7 DATE OF BIRTH Date (DD) Month (MM) Year (YYYY)

8 CATEGORY : CATEGORY CODE: (Gen - 1, SC-2, ST- 3, OBC-NCL- 4)

9 WHETHER PHYSICALLY HANDICAPPED/PwD(YES/NO) IF YES, CATEGORY OF PH (OH/HH/VH)

10 WHETHER EX-SERVICEMAN (YES/NO) IF YES, TOTAL SERVICE Years Months Days

11 QUALIFICATION (PGDPM/MBA/MSW/MA(PMIR)/DIPLOMA/B.COM/ITI)

12 DISCIPLINE IN QUALIFICATION (HR/PM/SW/ CIVIL ENGG/ COMMERCE/ ELCETRICAL)

13 YEAR OF PASS 14 PERCENTAGE OF MARKS . 15 DIVISION

16 INSTITUTE/ BOARD/ UNIVERSITY

17 COURSE DURATION (Years) 18 FULL TIME/ PART TIME/ CORRESPONDENCE

19 ADDITIONAL QUALIFICATION, IF ANY.

20 TOTAL POST QUALIFICATION EXPERIENCE, IF ANY. Years Months (Essential for Post Code AFA)

ORGANISATION PERIOD FROM

D D M M Y Y Y Y

POSITION WORK AREA PERIOD TO

21 EMPLOYMENT EXCH. REGD. DETAILS (IF ANY)

EMPLOYMENT EXCH. REGD. NO.
EMPLOYMENT EXCH. REGD. NO.

22 BANK DRAFT DETAILS Rs. DD NO.

DATE (DD/MM/YY) BANK

23 OPTION FOR LANGUAGE IN EXAMINATION (HINDI / ENGLISH)

24 CHOICE FOR TEST CENTRE (PATNA / RANCHI)

I CERTIFY THAT THE INFORMATION FURNISHED ABOVE IS TRUE & CORRECT. IN CASE ANYTHING IS FOUND TO BE FALSE, THEN MY
25 CANDIDATURE WILL BE REJECTED.

DATE : (SIGNATURE OF CANDIDATE)