PROFORMA OF APPLICATION To, The General Manager Small Arms Factory, Kalpi Road, Kanpur-208 009 Sub:- Application

for the Post of ____________________(Semi-Skilled) Ref:- Advertisement published in the Employment News Advertisement No. ____________________________ Dated ____________________ 1. Name of applicant: . IN FULL BLOCK LETTERS) 2. Father's Name . 3. (a) Date of Birth In (DD/MM/YY format) Day ______ Month ________ Year _________ Attested copy of Matriculation Certificates showing Date of birth to be enclosed) (b) Age as on the last date of receipt of application: Year ______ Month ______ Days ______ 4. (a) Details of Educational and other qualifications:Name of Examination Year of Name of Board/ Subject studied Passing University Division Percentage of Marks Remarks
one passport size photograph (not more than 03 months old) duly signed on it by the candidate is to be firmly pasted here (other two photographs duly signed on it are to be enclosed separately with the application)

(b) Details of passing NCTVT/ITI or equivalent examination: Trade Name of Ordnance Factory/ Institution Training Period NCTVT Year of Batch No. Passing From To Marks Obtained Out of Remarks

(c) Whether Departmental candidate/Employed in Govt./PSUs etc., if yes, give details (No Objection Certificate should be enclosed): Name of Dept./Office Designation & Pay Personal No. & Nature of duty Length of Service Scale Section (if any) performed

(Departmental candidate/employed candidate should send their application from through proper channel) 5. Whether Ex-serviceman, if so furnish details:

6. Whether PWD/PC, if so furnish details along with % of disability . (PWD/PC - Persons with disability/Physically challenged) 7. Original Category UR/SC/ST/OBC : (Attach caste certificate in case of reserved category) 8. Demand Draft/Indian Postal order No.: 9. Language Option for Examination (Hindi or English): 10. Nationality : .. 11. Permanent address : . . Pin Code No . 12. Present address for communication: . . Pin Code No . Tel.No / Mobile No . 13. Nearest Railway Station : 14. Left Hand Thumb Impression :

DECLARATION I do 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 particulars or information furnished by me, found false/incorrect/incomplete or ineligible, my candidature for the examination is liable to be rejected or cancelled and in the event of any statement/information found false even after appointment; my service are liable to be terminated without any notice. Signature of the candidate Place: Date: Name:

Encl: List of enclosures (Please tick). 1. Three passport size photographs duly sign by the candidate (01 pasted on the application form & 2 loose photographs be stapled with application form on top right side preferably putting in envelope). 2. 3. 4. 5. 6. 7. 7. 8. Proof of Date of Birth : Proof of Educational Qualification : Caste Certificate (in case of SC/ST/OBC) Non-Creamy Layer Certificate (in case of OBC Candidate) : Discharge Certificate (For Ex-serviceman only) : No objection certificate (For Departmental candidate/employed candidate only) : Disability Certificate (For PH Candidates) : All documents be page numbered.: