Railway Recruitment Cell Northern Railway Lajpat Nagar-I, New Delhi 110 024

APPLICATION FORM

Emp. Notice : 220E/Open Mkt/RRC/2012 Control No.

APPLICATION FORM NOT IN A-4 SIZE, 80 GSM PAPER & REPLICA WILL BE REJECTED

(Application Form only Downloaded from RRC website www.rrcnr.org will be accepted.) 1. Correspondence
Address : ( in CAPITAL)
( Use Black Ball Pen only )

NameAddressPaste your recent Photograph ( 3.5 cm X 2.5 cm ) Without Cap/Skull Cap/Muffler & Goggles

STATENearest Rly. Station-

PIN-

Applicants Signature

2. Applicants Name : ( in CAPITAL ) 3. Fathers/Husbands Name: (in CAPITAL) 4. Permanent Body Mark of Identification : 5. Phone with STD Code/Mobile no:
SCRIBE

DD

MM

YYYY Age as on
01-01-13

YY

MM

DD

OH-1 HH-2 VH-3

Required?

6. Date of Birth : 8. Sex : (M-1) (F-2) 10.Community:

7. Physically Handicapped:
Y/N

9. Religion: Hindu Muslim Christian Sikh Budhist Jain Parsi Other

1 2 3 4 5 6 7 8

UR OBC SC ST
1 2 3 4

11.Relaxation On:

OBC-1 SC-2 ST-3 ITI-4 PH-5 (OH/HH/VH) J&K-6 Separated/Divorced Women-7 Other-8 Passing Month/Year MM YY Percentage % (2+2)

12. Qualification : 13. Documents Enclosed : 14. Fees details :

10th 1

12th 2

ITI 3

Grad 4

1. 2.

3. 4.
Date Amount

5. 6.
Details of Bank / Branch / Post office

Bank Receipt No / IPO No

15. Declaration by the candidate: I, hereby declare that all statement in application are true and correct to the best of my
knowledge and belief. In the event of information being found False or Incorrect my candidature / appointment may be cancelled without any notice. (write this declaration below in your own hand writing).

Left Thumb Impression of Applicant

Applicants Signature

Date : Place:

(in English)( in Hindi ) -