Beruflich Dokumente
Kultur Dokumente
Application Format
Paste a recent
passport size
Photograph
here and sign
To, across it in full
Post Box No.8229, (Please hold
with you two
Dahisar (East) Post Office, copies of
Mumbai 400 068. same
photograph
With the reference to your advertisement for the recruitment of clerical staff, I submit my application in
under noted format:
1. Full Name: Shri/Smt/Kum:
(in block letters)
2. Sex: Male Female
3. a) Candidate’s Present address for Communication with Pin Code (in block letters)
City: ____________ Pin Code: ____________ State:
b) STD Code: _____________ Phone No:
c) Mobile No.______________email ID _______________________@
d) District you originally come from:
4. Centre for examination: _______________________ Centre Code:
5. Date of Birth (DD/MM/YYYY): / / / Age: Years Month
(Proof to be attached) (as on 01.04.2007)
6. Place of birth: ____________ 7. Nationality :_______________ 8. Religion:
9. Father’s / Husband’s Name: Shri.
10. Category to which you belong: (Tick under the correct category)
SC SC SC SC ST ST ST ST OBC OBC OBC OBC GEN GEN GEN GEN
(OH) ( (HI) (OH) ( (HI) (OH) (VH) (HI) (OH) (VH) (HI)
VH) VH)
For PWD candidates Do you intend to use the services of scribe Yes No
(Only for blind candidates & those whose writing speed is affected by cerebral palsy.)
11. To be filled in by those SC/ST/Minority Community/Exservicemen Candidates desirous of
Yes No
taking PreExamination Training.
i) Would you like to undergo PreExamination Training:
ii) Centre for PreExamination Training : Yes No
12. Indicate by Tick mark in appropriate box
i) Are you an Exserviceman
Yes
If yes, date of discharge _____Rank at present / last held________w.e.f. No
ii) Are you a widow, divorced woman, woman judicially separated from the husband & who is
not remarried? Yes No
iii) Are you a candidate who has ordinarily been domciled in Kashmir Division of the State of
J&K during the priod of 01.01.80 to 31.12.89
iv) Whether you belong to Minority Community
13. Educational Qualifications (as on 01.04.2007)
Sl. Name of Name of Examination Month & No of %age of
No University/Institut *Mandatory Year Attempt marks
. ion of passing s obtained
1. Madhyamik (Class X)*
2. Higher Secondary (Class
XII)*
3. Graduation*
4.
14. Computer Knowledge :
i) Course done : ______________________________________
ii) Name of Institution : _________________________________
15. Languages Known Language Read Write Speak
(Mark ‘X’ in the a) ____________________
appropriate box) b) ____________________
c) ____________________
16. Particulars of Application fees / Postal Charges
Name and Address Drawn in favour Payable at Demand Draft Date of Amount
of of No. Issue (Rs.)
issuing
Bank/Branch
State Bank of Mumbai
India
17. Are you applying separately for 100 vacancies in Sikkim, Andaman & Nicobar Islands, Ladakh
& Leh and Lakshadweep: Yes No
18. DECLARATION
I hereby declare that all statements made in this application are true, complete and correct to
the best of my knowledge and belief. I understand that in the event of any information being
found untrue or incorrect at any stage or my not satisfying any of the eligibility crietria
according to requirements laid down by the Central Recruitment and Promotion Department,
my candidature is liable to be cancelled. I am willing to serve anywhere in India including rural
area.
Place: __________________ Signature:
Date : __________________ Name of Candidate :
List of Enclosures :________ (in block letters)
RTI