Umed- Maharashtra Rural Livelihoods Mission (MSRLM)

State Mission Management Unit

Application for the post of ----------------------------

To, Self-Attested color

The Chief Executive Officer
Maharashtra State Rural Livelihoods Mission (MSRLM) Passport size Photograph
5th Floor, South Wing, CIDCO Bhavan,
CBD, Belapur, Navi Mumbai – 400 614

Sub: Application for the post of ----------------------------

SECTION A : Personal Details

1. Applicant Details
Name (first-middle-last) in Capital Letters

Date of birth (dd/mm/yyyy)

Age on 01/03/2018 (year, months &days)

Category (SC, ST, OBC, VJ A , NT B, NT C, NT
D ,SBC, OBC, Open)
Domicile of Maharashtra Yes/No

Are you from Handicap category Yes [ ] No [ ]

If yes, Handicap Type

Percentage of Handicap

Sex [ ] Male [ ] Female

Married Status Married [ ] Not married [ ]

Current Address

Tel. No.: Mobile No.:

Permanent Address
Email ID
SECTION B: Educational Details
1. Educational Details (From S.S.C. onwards)

College/ Institute /University/Board Mark Year of Subjects/ Specialization

Qualification % passing

S.S.C.

H.S.C.

Graduation in
-------
PG in ------

Other -----

2. Other professional qualification / Computer education details

 Sr. No. Other Certifications Board Year of Percentage /Grade
passing

1
2
3

SECTION C: Professional Details

1. Experience Details (Chronological order) (if applicable)
Sr. Name of Joining Leaving Total Experience Position Role / Nature of
Organizat (Year, Month & Days) he duties
ion ld

Total Experience

2. Knowledge of MS Office - ------------- (Yes / No)

3. Language Proficiency:

Languages Known Read (Yes/ No) Write (Yes/ No) Speak (Yes/ No)

Marathi
English
Hindi

4. Details of the current / last employment: (if applicable)

Current/Last Employer Place Per month Salary in Rs. Annual Salary in Rs.

I hereby declare that all 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
suppressed/false or incorrect or any ineligibility being detected before
or after the examination, my Candidature/ appointment is liable to be
cancelled.
I know that mere eligibility doesn't guarantee a job. Based on
application received MSRLM reserves the right to shortlist candidates
based on qualification. Signature
Note: Candidate should attach self-attested photocopy of all necessary documents (ID proof, Address
proof, Age certificates, educational certificates, Experience certificates, Cast certificate (if
applicable), Caste validity (if applicable), Non creamy layer (if applicable) etc.) along with this
application form.