ZONE-WISE RECRUITMENT for

MANAGEMENT TRAINEE (General/ Depot/ Movement/ Accounts/ Technical/ Civil Engineering/ Mechanical
Engineering/ Electrical Engineering) AND MANAGER (HINDI)

Registered Application Form

Application Form for the Post of
Zone Applied For
Registration Number

: Management Trainee (Depot) (B)

: SOUTH
: 2231520102190

1.

Candidate's Name

2.

: PETTA VIJAY KUMAR

(Name as recorded in the Matriculation /
Secondary Examination Certificate)
: PETTA BULLI RAJU
: PETTA VEERA VENI
: MALE
: 19-Oct-1982

(a) Father's Name

(b) Mother's Name
Gender
Date of Birth
(As recorded in the Matriculation /
Secondary Examination Certificate)
Age (as on 01.08.2015 )
:
Category
:
Whether Domiciled in the State of :
Jammu and Kashmir during the period
01-01-1980 to 31-12-1989
Whether Ex-Servicemen
:
Whether Person with Disabilities (PWD) :
/ Physically Handicapped (PH)
Whether Departmental (FCI) Employee :
Whether belonging to Minority :
Community
Nationality
:
Zone Applied For
:
Name of the Written Test Center
:
Post Applied For
:

3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

16. Educational Qualification

(a) Name of Academic / Professional :
Degree / Diploma (which makes you
eligible)
(b) Name of the University / Board
:
(c) Whether Recognized University or :
equivalent / an Institution approved by
the UGC or AICTE or UGC-AICTEDEC Joint Committee
(d) Year of Passing
:
(e) Duration of Course / Programme
:
(f) Percentage of Marks
:
(g) Remarks, if any
:
17. Whether Educational Qualification
completed
18. (a) Email Id
(b) Confirm Email Id
19. Mobile Number
20. Experience
21. Communication Address
Address Line 1
Address Line 2
City
District

22. Photo

23. Signature

32 Year(s) 09 Month(s) 13 Day(s)

SC
NO
NO
NO
NO
NO
INDIAN
SOUTH
Hyderabad
Management Trainee (Depot) ( B )
Graduate Degree or Equivalent from recognized University
GODAVARI INSITUTE OFENGINEERING AND TECH JNTUH
YES

2008
04 (in Years)
55 %

: YES
:
:
:
:

VIJAYKUMAR550@GMAIL.COM
VIJAYKUMAR550@GMAIL.COM
9985767618
NO

:
:
:
:

5129
KATHERU MALLAYYAPETA
RAJAHMUNDRY RURAL
EAST GODAVARI

Pin Code
State
24. Whether FEE Paid

: 533105
: Andhra Pradesh
: Exemption Claimed

25. Declaration
1. I have not submitted any other application for this examination. I am aware that if I contravene this rule, my
application will be rejected summarily by FCI.
2. I have read the provisions in the Advertisement carefully and hereby undertake to abide by them.
3. I further declare that I fulfill all the conditions of eligibility regarding age limits, educational qualifications,
experience etc. prescribed for the post applied for.
4. I also declare that I do not stand debarred by FCI as on date and have never been convicted by any court of law.
I also declare that no charge sheet is pending against me in any court of law. Further declare that I have never
been dismissed or compulsorily retired from the service of the Corporation or from a Department of a State or the
Central Government or from any Public Sector Undertaking or my service been terminated during probation.
5. For Candidate belonging to OBC I declare that I belong to the community, which is recognized as backward class by the Govt. of India for the
purpose of reservation in services as per order contained in Deptt. of Personnel and Training Office
Memorandum No. 36012/ 22/ 93-Estt.(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 Advertisement. I further declare that I am in possession of OBC
Certificate in the prescribed format given in the Advertisement.
6. I hereby declare that there is no Vigilance / Disciplinary case pending against me. I am in possession of No
Objection Certificate from my employer which shall be required to be sent along with other essential enclosures
in case of my shortlisting on the basis of the Written Test at the designated Address which shall be informed /
notified through the designated website (www.fcijobsportal.com)
7. I hereby declare that self-certified 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 cancelled without any notice.
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 conformity with the eligibility criteria mentioned in the
advertisement at any point of time my candidature / appointment may be cancelled / terminated without any notice
and / or I shall be liable for any other action under the extant rules.
Date: 25-Jun-2015
Place: ____________

Signature of Candidate: _______________

Candidate's Name (in Capital Letters): _______________