Beruflich Dokumente
Kultur Dokumente
3. Application for examination should be filled in by the candidate and shall sign on it.
10. Any person making a false statement for the purpose of the admission to the
examination renders himself liable to prosecution.
c. A Candidate who has paid the examination fee but is found ineligible for an
examination shall forfeit the said fee.
To,
The secretary,
Boiler Operation Engineers Examination Board,
Karmika Bhavana, 2nd Floor, Dairy circle,
Bannergatta Road, Bangalore560029
Contact no 08026531203/204
14. The last date for the receipt of application is 15th May 2017.
Contd..Annexure
Page 2
Annexure I
Format of practical experience certificate / service certificate and Testimonials of good character with
age from the employer
To be issued on the letter head of the concerned mill/factory/workshop
4. Heating Surface(m2)
5. Type of Boiler
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Annexure II
A candidate, in order to be qualified for a certificate of Proficiency under rules, Shall, inter alia, satisfy
the examiners that he
******
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FORM A
(See Rules 26 and 41 of Boiler Operation Engineer Rules 2011)
PART I
2. Fathers Name :
3. Nationality :
Affix your Latest
Passport size
4. Date of Birth : Photograph here
5. Place of Birth :
6. Permanent Address :
NOTE:
1. Every application must be accompanied with the requisite fee in the manner as may be prescribed
by the Government.
2. Two copies of recent passport size photographs of the applicant shall accompany
the application which shall bear the signature of the applicant on the back.
3. Any, person making a false statement for the purpose of the admission to the examination
renders himself liable to prosecution.
4. Incomplete application is liable to be rejected.
Page 1
PART-II
Page 2
PART-III
(The Testimonials to be numbered serially corresponding to the Numbers given in column 1 below)
Number,
Address and
Sl.No Name of the Type and
Designation of Capacity
of the Date of person Heating Period for which Not to be filled in by the
Factory or in which Service of Applicant
Testim Testimonials signing the Surface of employed Applicant
workshop where employed
onials Testimonials Boilers
employed
worked on
Date of Date of
Initial of
Commen- Termina- Year Month Days Remarks
Verifier
cement tion
1 2 3 4 5 6 7 8 9 10 11 12 13
Total Service:
Time Served for which Certificates are produced:
Time Served for which No Certificates are produced page 3
PART IV
DECLARATION TO BE MADE BY THE APPLICANT
I do hereby declare that the statements made in Part I,II and III of this Form are correct and true to the be
st of my knowledge and belief and that the papers enumerated in Part II and submitted with this form are
true and genuine documents and further that the copies of the documents submitted with this
form are true and correct. I further declare that the statements made in Part III contain a true and correc
t account of the whole period of my service without exception, and I make this declaration conscientious
ly believing the same to be true.
PART V
(Not to be filled by the applicant)
Board of Examiners:-
1. 4.
2. 5.
3. 6.
(Secretary) (Chairman)
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