Shiftenggapplication2019
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APPLICATION FORM ( for the posts of Shift Engineer in Modern Rice Mill)
Post applied for
Please affix recent passport size phot here
SHIFT ENGINEER
Advertisement No. and Date
1
Name of the Candidate (IN BLOCK LETTERS)
2 Gender (Tick in relevant Box)
Male
3 Date of Birth
Date
4
Month
Year
Age as on 1st July of the year 2018 (in completed years)
5 Father's Name 6 Mother's Name Marital Status (Tick in relevant Box) Spouse Name 8 Husband / Wife 7
Married
Ummarried
9 Place of Birth 10 Native District and State 11 Mother Tongue 12 Other languages known 13
Nationality (Tick in relevant Box)
Indian
14 Religion (Please specify) 15 Address for Communication Door No.
Street:
City/ Village:
District:
State:
Pincode:
16 Permanent Address: Door No.
Street:
City/ Village:
District:
State:
Pincode:
Others
17
Communal Category (Please tick in relevant box)
OC
BC
MBC
SC
SC(A)
ST
DNC
18 Name of the Sub-caste a Community Certificate No. b Date of Issue c
Date
Month
Year
Issuing Authority
d Name of the Taluk:
19 Educational / Technical Qualification
Name of the District: Medium of Instruction
Name of the Institution
Year of passing
Total Marks
Marks secured
%
Grade/ class
a S.S.L.C. b H.S.C. (+2) c
Diploma in Engineering (Mechanical / Electrical)
d Others e Experience
20
21
Details of Present Employment if any
Name and address of the Institution
Designation
Scale of Pay
From
Details of conviction/ Punishment / Disqualification / Criminal case, disciplinary proceedings etc., if
22 Mobile No. / Phone No. 23 E.mail address 24 Declaration:I hereby, declare that all the particulars furnished in this application are true, correct and complete to the best of my knowledge and belief. In the event of any information being found false or incorrect or eligibility being detected at any stage, action can be taken against me by TNCSC. Date: Place: Encl.: 1) Self attested Xerox copies of Certificates 2) Recent Passport size photograph 2Nos. \\192.168.100.11\ho1\sr\ESTT\AE15\appointment\SE 2018\[Application-2019.xls]S.E.
Signature of the Candidate
Post applied for
Please affix recent passport size phot here
SHIFT ENGINEER
Advertisement No. and Date
1
Name of the Candidate (IN BLOCK LETTERS)
2 Gender (Tick in relevant Box)
Male
3 Date of Birth
Date
4
Month
Year
Age as on 1st July of the year 2018 (in completed years)
5 Father's Name 6 Mother's Name Marital Status (Tick in relevant Box) Spouse Name 8 Husband / Wife 7
Married
Ummarried
9 Place of Birth 10 Native District and State 11 Mother Tongue 12 Other languages known 13
Nationality (Tick in relevant Box)
Indian
14 Religion (Please specify) 15 Address for Communication Door No.
Street:
City/ Village:
District:
State:
Pincode:
16 Permanent Address: Door No.
Street:
City/ Village:
District:
State:
Pincode:
Others
17
Communal Category (Please tick in relevant box)
OC
BC
MBC
SC
SC(A)
ST
DNC
18 Name of the Sub-caste a Community Certificate No. b Date of Issue c
Date
Month
Year
Issuing Authority
d Name of the Taluk:
19 Educational / Technical Qualification
Name of the District: Medium of Instruction
Name of the Institution
Year of passing
Total Marks
Marks secured
%
Grade/ class
a S.S.L.C. b H.S.C. (+2) c
Diploma in Engineering (Mechanical / Electrical)
d Others e Experience
20
21
Details of Present Employment if any
Name and address of the Institution
Designation
Scale of Pay
From
Details of conviction/ Punishment / Disqualification / Criminal case, disciplinary proceedings etc., if
22 Mobile No. / Phone No. 23 E.mail address 24 Declaration:I hereby, declare that all the particulars furnished in this application are true, correct and complete to the best of my knowledge and belief. In the event of any information being found false or incorrect or eligibility being detected at any stage, action can be taken against me by TNCSC. Date: Place: Encl.: 1) Self attested Xerox copies of Certificates 2) Recent Passport size photograph 2Nos. \\192.168.100.11\ho1\sr\ESTT\AE15\appointment\SE 2018\[Application-2019.xls]S.E.
Signature of the Candidate
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