04/03/2015

RegistrationSlip
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FOODCORPORATIONOFINDIA
ADVERTISEMENTNO.3/2015FCICATEGORYIII
ZONEWISERECRUITMENTfor
JuniorEngineer(JE)(CivilEngineering/ElectricalEngineering/MechanicalEngineering),
AssistantGradeII(Hindi),Typist(Hindi)andAssistantGradeIII(General/Accounts/Technical/Depot)

RegisteredApplicationForm
ApplicationFormforthePostof:AssistantGradeIII(General)(F)NORTHZONE
RegistrationNumber:16360396921
1.Candidate'sName:

RAHULKESWAL
(NameasrecordedintheMatriculation/SecondaryExaminationCertificate)

2.(a)Father'sName:

MOHANCHANDKESWAL

(b)Mother'sName:

ANJUBALA

3.Gender:

MALE

4.DateofBirth:
(AsrecordedintheMatriculation/
SecondaryExaminationCertificate.)

05/03/1991

6.Category:

SC

5.Age:

22.Photo

23Year(s),9Month(s),27Day(s)
ason(01.01.2015)
23.Signature

7. Whether Domiciled in the Kashmir Division in the State of Jammu and NO

Kashmirduringtheperiod01011980to31121989:
8.WhetherExServicemen/AvailedthebenefitsofExServicemen:

NO

9.WhetherPersonwithDisabilities(PWD)/PhysicallyHandicapped(PH):NO

10.WhetherDepartmental(FCI)Employee:NO
11.WhetherbelongingtoMinorityCommunity:NO
12.Nationality:INDIAN
13.ZoneAppliedFor:

NORTH

14.NameoftheWrittenTestCenter:

NewDelhi

15.PostAppliedFor:

AssistantGradeIII(General)(F)

16.EducationalQualification
(a) Name of Academic/
ProfessionalDegree/Diploma
(whichmakesyoueligible):

GraduatedegreeinanydisciplinefromarecognizedUniversity

(b) Name of the University /

Board:

DELHIUNIVERSITY
(WhetherRecognizedUniversity/anInstitutionapprovedbyAICTEorBoard):YES

(c)YearofPassing

2013(Year)

(d) Duration of Course /

Programme:

36(inMonths)

(e)PercentageofMarks:

50.05%
(Marks up to 2 decimal points in aggregate of all years/ semesters (In case of CGPA / OGPA / Letter Grades, it is
equivalentpercentage(%).

(f)Remarksifany:

17.Whethercompleted:

YES

18(a).EmailId:

keswalrahul@gmail.com

(b).ConfirmEmailid:

keswalrahul@gmail.com

19.MobileNumber:

9999905230

20.Experience:

NO

Doyouhave:

ProficiencyinuseofComputers

YES

21.CommunicationAddress:

https://fcijobsportal.com/AGIII2014/pages/RegSlip.aspx

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04/03/2015

RegistrationSlip

(a).AddressLine1:

T101,SHUKKARBAZARROAD,GALINO.3

(6).AddressLine2:

UTTAMNAGAR

(c).City:

NEWDELHI

(d).District:

NEWDELHI

(e).PinCode:

110059

(f).State:

Delhi

24.WhetherFEEPaid:

ExemptionClaimed

25.Declaration:
i. Ihavenotsubmittedanyotherapplicationforthisexamination.IamawarethatifIcontravenethisrule,myapplicationwillberejectedsummarilyby
FCI.
ii. IhavereadtheprovisionsintheAdvertisementcarefullyandherebyundertaketoabidebythem.
iii. I further declare that I fulfill all the conditions of eligibility regarding age limits, educational qualifications, experience etc. prescribed for the post
appliedfor.
iv. IalsodeclarethatIdonotstanddebarredbyFCIasondateandhaveneverbeenconvictedbyanycourtoflaw.Ialsodeclarethatnochargesheetis
pendingagainstmeinanycourtoflaw.FurtherdeclarethatIhaveneverbeendismissedorcompulsorilyretiredfromtheserviceoftheCorporationor
fromaDepartmentofaStateortheCentralGovernmentorfromanyPublicSectorUndertakingormyservicebeenterminatedduringprobation.
v. ForCandidatebelongingtoOBC
IdeclarethatIbelongtothecommunity,whichisrecognizedasbackwardclassbytheGovt.ofIndiaforthepurposeofreservationinservicesasper
order contained in Deptt. of Personnel and Training Office Memorandum No. 36012/ 22/ 93Estt.(SCT) dated 8.9.1993. I also declare that I do not
belong to the person / sections (creamy layer) mentioned in column 3 of the schedule of the OM mentioned above and modified vide Govt. of India
DOPT OMs mentioned in the Notice. I further declare that I am in possession of OBC Certificate in the prescribed format given in the Notice of the
Advertisement.
vi. IherebydeclarethatthereisnoVigilance/Disciplinarycasependingagainstme.IaminpossessionofNoObjectionCertificatefrommyemployer
whichshallberequiredtobesentalongwithotheressentialenclosuresincaseofmyshortlistingonthebasisoftheWrittenTest/Skilltestatthe
designatedAddresswhichshallbeinformed/notifiedthroughthedesignatedwebsite(www.fcijobsportal.com)
vii. I hereby declare that selfcertified copies of relevant certificates / documents are in my possession. In case, selfcertified copies of the relevant
certificates / documents are not provided by me along with the Registered Online Application Form Printout, if called for, my candidature will be
cancelledwithoutanynotice.
I hereby declare that all the information given/ statements made by me in the application are true, complete and correct to the best of my
knowledge and belief and nothing has been concealed or suppressed. In the event of any information being found false or incorrect or is not in
conformitywiththeeligibilitycriteriamentionedintheadvertisementatanypointoftimemycandidature/appointmentmaybecancelled/terminated
withoutanynoticeand/orIshallbeliableforanyotheractionundertheextantrules.

Date:04Mar2015Signature:
Place:Candidate'sName(inCapitalletters):

(PleasePrinttheformforFurtherReference)

https://fcijobsportal.com/AGIII2014/pages/RegSlip.aspx

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