Application Form Recruit Em En Tad 5 June 09

APPLICATION FORMAT

(To be filled by the candidates in his/her own handwriting in capital letters) I hereby apply for the post of _____________________________ Medium for Written test (English / Hindi) ____________ 1

2

Candidates to affix recent passport size photograph self attested at the top

NAME OF CANDIDATE (As recorded in the Matric/ Secondary School Certificate) PARENT’s NAME OCCUPATION ADDRESS

3

FULL POSTAL ADDRESS FOR COMMUNICATION (With Pin code No.)

4

DATE OF BIRTH

In figures D

5

CATEGORY (Please tick)

D

SC

M

ST

In words M

Y

OBC

Y

GEN

PH

EXSM

If PH specify nature and percentage of disability _________________________________________ 6

STATE OF DOMICILE

7

NATIONALITY

8.

CONTACT No. and E-Mail id (if any)

9. Educational Qualification (Matric/SSC onwards): Name of Board / Institute

Exam Passed

Duration Of Course

Year of Passing

% of Marks Obtained

10. Details of employment, If any Name & Employer

Address

11. Demand Draft Details :

of

Post held

Nature of job

Period of service From To

Salary / month

DD No.

Name of Issuing Bank

Date of Issue

2 0 0 9 Name of Issuing Branch

Reason for leaving

I hereby declare that I have read all the conditions mentioned in the advertisement and I fulfill the same. The 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 particular or information given herein being found false or incorrect, my candidature is liable to be cancelled and in the event of any misstatement/discrepancy in the particulars being detected after my appointment, my service is liable to be terminated without any notice to me. Date : …………….

Place : ………………….

Signature………………………

Note: 1. Candidates must write name of the post applied for on the top of envelope containing application form. 2. In case of SC/ST/OBC/PH/Ex-Servicemen, copies of the following documents are to be attached; failing which the application would be considered without any relaxed criteria. a) Certificate of proof of caste issued by Competent Authority. b) Certificate of proof related to physically handicapped / Ex-Servicemen. 3. All certificates in support of educational qualifications, Date of birth, past employment etc. to be attached 4. Applications received after due date would be summarily rejected. LIST OF ANNEXURES: 1. 2. 3. 4. 5. 6.