Recruitment Officer Clerk Saptagiri Form

AFFIX PHOTO

APPLICATION FORMAT APPLICATION FOR THE POST OF _______________________ CODE NO……. SAPTAGIRI GRAMEENA BANK RECRUITMENT PROJECT 2009 (Fill all columns in legible capital letters in his / her own handwriting and use 8.27’x11.69’ size paper – A4 size)

To SAPTAGIRI GRAMEENA BANK RECRUITMENT PROJECT 2009, POST BOX NO. 27697 MALAD (East) MUMBAI -400 097 for Officers/ * POST Box No: 8242, DAHISAR (EAST) MUMBAI -400 068 for Clerk Cum Cashiers (* Delete which ever is not applicable) With reference to your advertisement dated 18-04.2009, I submit my application in the Prescribed format for the post of _________________________________. 1.

FULL NAME IN BLOCK LETTERS : (Leave one space blank between two parts of your name)

2.

ADDRESS FOR COMMUNICATION :

PIN 3.

CENTRE OF EXAMINATION : ___________________________ (IN BLOCK LETTERS) CENTRE CODE : (Please refer to Point 8 of the advertisement)

4.

POST APPLIED : _____________________________POST CODE_____ (Please refer to Point 2 of the advertisement)

5. ADDITIONAL POSTS APPLIED : Have you sent a separate application with requisite fee for the other post also ? (Please indicate by puttying √ in the appropriate BOX) YES NO

6.

GENDER : MALE

FEMALE

(Please indicate by puttying √ in the appropriate BOX) 7. (i) CATEGORY TO WHICH THE CANDIDATE BELONGS : (Pleasure enclose attested copy of Caste Certificate in case of SC / ST / OBC)

SC

ST

OBC

General

Please indicate by putting √ in the appropriate BOX) (ii) INCASE OF PERSONS WITH DISABILITY : OH

Percentage of disability _________________ (Please enclose attested copy of Medical certificate issued by Medical Board at District Level)

(Please indicate by putting √ in the appropriate BOX) (ii) (b) Are you eligible and intend to use the service of a scribe ? (Please indicate by putting √ in the appropriate BOX) YES NO

8.

DATE OF BIRTH :

DD

MM

YY

AGE : (As on 31.3.2009 _____________________ Years) (As per School leaving certificate / SSLC / SSC) Relaxation in age (if claimed) : No of years _____Under category _______ 9. PARTICULARS OF FEES (Demand Draft) : For General and OBC candidates -Rs. 300/For SC, ST, Persons with Disabilities & Ex-Servicemen candidates-Rs. 50/- (* towards postal charges) Name & Address of issuing Name & Address of the Date of Issue D.D. No. Amount bank / branch drawee Bank (in Rs.)

Examination Fees should be sent in the form of Demand Draft payable to Saptagiri Grameena Bank – Recruitment Project 2009 payable Chittoor only. Cash, Cheque, Money Order, Postal Orders, Postal Stamps will not accepted. 10. To be filled in only by those SC / ST / Ex-Servicemen / Religions Minority Community candidates, who are desirous of taking Pre-Examination Tranining. (i) WOULD YOU LIKE TO UNDERGO PRE-EXAM TRAINING (Please indicate by putting √ in the appropriate BOX) YES NO (All expenses regarding traveling, boarding, loading etc. will have to be borne by the candidate for attending the pre-examination training programme at the Training centre) 11.YOUR CONTACT NO (with STD Code) : TELEPHONE: MOBILE NO. E-MAIL : __________________ 12.

INDICATE BY : MARK IN APPROPRIATE BOX : (I) Are you and Ex-serviceman ? YES NO

(a) In case of Ex-serviceman / Commissioned Officer / Police Officer / Other equivalents.

Specify 1. Date of Discharge : ______________________________________ 2. Rank at present / last held a) Acting : ______________ w.e.f. _________ b) Substantive ________ w.e.f. _____________ (ii) Whether you belong to Religious Minority Community ? (Please indicate by putting √ in the appropriate BOX) YES

(iii)

NO

If yes please state the religion : _________________ In case of SC / ST / OBC Candidate a) Name of the Caste / Tribe / Class _______________________

(iv) Whether you are a domicile of Jammu & Kashmir during the period from 01.01.1980 To 312.12.1989. (Please indicate by putting √ in the appropriate BOX) YES

(v)

NO

Whether you are a widow YES

NO

13.

Father’s/Husband’s Name:__________________________________

14.

Nationality : _________________

15. Place of Birth : Place _______________________ Dist ______________ State ____________ 16.

State

Permanent Address :

PIN Are you a native / resident of Andhra Pradesh: Yes/ No (Please indicate by putting √ in the appropriate BOX) YES NO If Yes, have you enclosed Nativity certificate / Certificate of Residence ?

17. EDUCATIONAL / PROFESSIONAL QUALIFICATION (As on 31.3.2009) Name of the University/ Stream/ Discipline Month & Year % age of Examination Passed Institution Studied of passing marks 10inStd. 12inStd. Graduation Post Graduation Others (Particulars from Matriculation / SSLC / SSC onwards) 18. Particulars of previous employment including the present Occupation / Job, if any: Name of the employer/ Designation Period of Service Length of Nature of Remarks Firm etc. and the and rank, if service: duties (Reasons for nature and the details any Years/ performed in leaving servces) of activities carried out Months/ detail by the employer Days From To

19.

Languages Known

: (Please write the Language name)

READ

WRITE

SPEAK

20.

Any other information: ____________________________________

BEFORE MAILING APPLICATION PLEASE CHECK THAT YOU HAVE FURNISHED THE FOLLOWING PARTICULARS: 1. Please ensure the correctness of the Post name and Post Code that you have applied for. 2.

The centre where you wish to appear for the written examination.

3.

Please specify Category / sub-category correctly. Necessary certificates for SC / ST / OBC / Persons with Disabilities are to be enclosed.

4.

Details regarding fees (Demand Draft). Please write your name, post code and centre of exam on the back of the Demand Draft.

5.

Address for Correspondence.

6.

Separate application form with requisite fees for each post is sent.

7.

Details of claiming relaxation in age along with copies of the relevant certificates.

8. 9.

An attested copy of Nativity / Certificate of Residence is enclosed. The

envelope

is

to

"APPLICATION

FOR

_____

Grameena

Saptagiri

be

THE POST Bank

super scribed

with

the

words

OF _____________ Post Code No. Recruitment

Project

2009,

Centre:

____________________

, Centre code

DECLARATION I hereby declare that all 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 information being found false or incorrect at any stage or not satisfying the eligibility criteria according to the requirements of the relative advertisement, my candidature / appointment for the said post is liable to be cancelled / rejected at any stage and if appointed, my services are liable to be cancelled / terminated. I have not been debarred from taking up the test / selection by any Bank / IBPS and I have not been convicted in any criminal case. I am willing to serve any where, if selected. I agree that the Bank has the right to transfer me to any place at its discretion. I hereby agree that any legal proceedings in respect of any matter(s) or claims or disputes arising out of this application and / or out of the said advertisement can be instituted by me only before the Courts / Tribunals / Forums at Salem and they also shall have the sole and exclusive jurisdiction to try any case / dispute. I undertake to abide by all the terms & conditions mentioned in the advertisement given by the Bank and other further communication / intimation / notification with regard to this recruitment. Place : Date :

Signature of the Applicant