CABINET SECRETARIAT

Note: please fill the application form in English Capital letters. Advt.No. 06/13 Post applied for (Tick against relevant post) Lower Division Clerk Assistant

1.

Name

2.

Address for Correspondence (Please mention PIN code and name of STATE clearly)

PIN STATE 3. Contact No. (Mobile/Landline) 4. Fathers Name : :

5.

Date & Place of Birth

6.

Age as on closing date

(as on 14.02.2014)

Years

Months

Days

7.

Code for category (Refer note II)

8. i) ii) iii)

If ex-serviceman, please indicate:Length of Service Date of Joining Date of Discharge (Enclose copy of discharge Certificate) : : Years Months Days

___________________

____________________

9. Sex 10. Nationality 12. Marital Status

: : :

____________________ ____________________ ___________________ b) Nationality of Spouse : ___________________ 11. Religion : ___________________

If married, a) Religion of Spouse :______________

Contd

13. Educational Qualifications:Exam/ Degree Passed University/Board Year of Passing Duration of the Degree/Diploma Subjects Studied Aggregate marks with Percentage

14. Whether employed or not

___________________________________

15. If Yes, Details of Employment in Chronological order:Office/Institute/ organisation Post Held Ad-hoc/Regular /Tem./Pmt. Exact date to be given From To Scale of Pay Nature of Duties

16. Computer Knowledge, if any 17. Typewriting speed

: :

_____________________________________ _____________________________________ Language Read Write Speak

18. Language Known (Indian/Foreign) : With proficiency to read, write & speak

19. Examination Centre : ( Tick against relevant column)

Delhi

Mumbai

Kolkata

Chennai

Lucknow

Shillong

Jammu

(Note: The Department reserves the right of final allotment of examination center) DECLARATION I hereby declare that a) I fulfill the eligibility for the post applied for ; b) I have not submitted any Other application in response to the same advertisement. In the event of information or part thereof being found incorrect At any stage, my candidature/appointment is liable to be cancelled / terminated without any notice to me and action can be taken against me.

Place : Date:

Signature of the applicant