Information Sheet

Annexure-2 RAILWAY RECRUITMENT BOARD______________ INFORMATION SHEET (For Joint Employment Notice No.01/2009) (To be filled in CAPITAL LETTERS only - Signature should not be in Capital / Open letters) 1.

NAME OF CANDIDATE

2.

Tick () Gender

3.

Nationality :

4.

Permanent Address : ...........................................................................................................................................................................................

Female

Male

Marital Status

Married

Unmarried

............................................................................................................................................................................................................................. ..........................................................................................State.............................................................................Pin......................................... 5.

Details of Postal Orders (IPO) / Demand Drafts (DD) enclosed

Name of Post Office / Bank

Muslim

Serial No. and Date

6.

Religion : Hindu

7.

Are you (i) Govt. Employee

8.

Present employment (To be filled by all Railway / Central / State / PSU employees)

Yes/No

Designation & Grade

9.

Sikh

(ii) Ex-Serviceman

Date from

Buddhist Yes/No

Jain

Do you seek age relaxation

() TICK appropriate box

(iii) Physically Handicapped

Date to

Others

Yes/No

Name & address of Employer

Date of Attestation

SC

ST

Date of Discharge

OBC Judicially separated / divorced woman / widow

Ex-SM

Whether you were debarred by any RRB in the past

12.

Documents attached in proof of : Indicate by () tick mark in the relevant boxes indicated below Community

IPO/DD

Certificate for (SC/ST/OBC)

Self Declaration from OBC candidates as per Annexure-5

a) No

J&K Resident

Length of Service

11.

13.

Parsi

Ex-Serviceman (Ex-SM) Date of Enrolment

10

Christian

Amount

Discharge Certificate (for Ex-serviceman)

Declaration from visually handicapped candidates as per Annexure - 8

b) For 2 years

Course Completed Act. Apprentice

PWD

c) For life

Disability Certificate (for PWDas per Annexure-7)

Qualification Certificate

Railway Employee

Vision Certificate (required for the post of ASM/ALP/Motorman as per Annexure.-6)

Matric/SSLC Certificate (for DOB Proof)

Please copy the following declaration in your own hand-writing in running hand in the space provided below: "I hereby declare that all the statements made by me in the application are true and complete to the best of my knowledge and belief and nothing has been concealed or suppressed. I also understand that in case, any of my statements is found untrue during any stage of recruitment or thereafter, shall disqualify me for the post applied for and I shall also be liable for any other action under the extant rules".(Not filling up the above passage will disqualify you)

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Place : Date :

Left Thumb Impression of candidate in this box —>

Signature of the Candidate (Not in Capital Letters)