Annexure-1

RAILWAY RECRUITMENT BOARD______________ Roll No. (For official use only)

APPLICATION FORM FOR JOINT EMPLOYMENT NOTICE NO.01/2009 Control No.: (For official use)
PLEASE FILL UP THE APPLICATION IN CAPITAL LETTERS IN OWN HANDWRITING.

Signature should not be in Capital letters.

Paste (do not pin or staple)
(All applications must be submitted in A4 size 80 GSM paper) (bond paper) here your recent colour passport size
photograph of size 4 cm x 5 cm
1. CATEGORY No. & POST (The colour photograph
(for single category) Cat. No. Name of Post should not be more than
3 months old)
Indicate options below in order of preference where single application is prescribed for Not to be attested
more than one category (you will only be considered for the post(s) indicated below)

Option Cat. No. Post Option Cat. No. Post

1 3

2 4

Signature of candidate in the above

2. Choice of Railway 1st 2nd 3rd box below the photograph
(wherever applicable)

3. NAME OF CANDIDATE

4. COMMUNITY (Tick 3) UR OBC* SC ST

*OBC Certificate to be submitted in the form as prescribed in Annexure-4 of Employment Notice. OBC Certificate older than one year from the date of closure of Employment Notice and
without Non-creamy layer certification is not valid and will be rejected

5. FATHER'S NAME

6. DATE OF BIRTH (DD/MM/YYYY)

7. AGE (as on 01.07.2009 ) years months days

(Refer para 2 of Employment Notice)

8. VISIBLE MARK OF IDENTIFICATION ON BODY

(To be filled compulsorily)
9. Qualification (Fill in only those qualifications prescribed for the posts applied for)
Year of
(A) Academic Qualification University / Board Subjects Marks %
passing
SSC / X / Matric
Higher Secondary / XII / Inter
Graduation
Post Graduation
Others
Year of
(B) Technical Qualification University / Board Discipline / Trade Marks %
passing

I.T.I/Act Apprentice
Diploma
Engineering Degree
Others

10. ADDRESS
(FOR CORRESPONDENCE)

State............................................................................... PIN CODE

11. NEAREST RAILWAY STATION

(For issue of free Railway pass to
SC/ST candidates)

Left hand Thumb Impression

of candidate in this box — >
Signature of the Candidate
(Not in Capital letters)
Note : 1) Candidates must fill up their name, father's name and date of birth as indicated in their Matriculation Certificate.
2) Candidates should put their full signature at all the places in the same language (in English or in Hindi).
 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 (3) Gender Female Male Marital Status Married Unmarried 3. Nationality

4. Permanent Address :

State PIN Code

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

Name of Post Office / Bank Serial No. and Date Amount

6. Religion : Hindu Muslim Christian Sikh Buddhist Jain Parsi Others

7. Are you (i) Govt. Employee Yes/No (ii) Ex-Serviceman Yes/No (iii) Physically Challenged Yes/No

8. Present employment (To be filled by all Railway / Central / State / PSU employees) VH HH OH
Designation & Grade Date from Date to Name & address of Employer

9. Ex-Serviceman (Ex-SM)

Date of Enrolment Date of Attestation Date of Discharge Length of Service

10. Do you seek age relaxation Judicially separated / J&K Railway Course Completed
SC ST OBC Ex-SM PWD
(3) TICK appropriate box divorced woman / widow Resident Employee Act Apprentice

11. Whether you were debarred by any RRB in the past a) No b) For 2 years c) For life
12. Documents attached in proof of : Indicate by (3) tick mark in the relevant boxes indicated below
Community IPO/DD Discharge Certificate Disability Certificate Vision Certificate
(for PWD as per Annexure-7) (required for the post of
Certificate (for Ex-serviceman)
ASM/ALP/Motorman
(for SC/ST/OBC)
as per Annexure-6)
Self Declaration from OBC Declaration from Qualification
visually handicapped candidates Matric/SSLC Certificate
candidates as per Annexure-5 as per Annexure - 8 Certificate (for DOB Proof)
13. Please copy the following declaration in your own handwriting 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)

Left Thumb Impression

Signature of the Candidate
Place : of candidate in this box — >
(Not in Capital letters)
Date :