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Free of Cost

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Form ‘A’

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Application form for Enrollment as Civil Defence Volunteer
1- iwjk uke@Name in Full:...............................................................................................................
2- firk@ifr dk uke@Father’s/Husband’s Name:............................................................................ gky gh esa
3- tUe frfFk@Date of Birth:............................................................................................................ f[kpok,a x,
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4- jk’Vªh;rk@Nationality:................................................................................................................. vkdkj ds
5- igpku fpUg@Identification Mark:............................................................................................... QksVksxzkQ dks
6- (d) orZeku irk fuokl LFkku (Fkkuk lfgr)@ fn,s x, LFkku
Present Residential Address with Police Station:.............................................................. ij fpidk,
..........................................................................................................................................
([k) LFkk;h irk@Permanent Address:..............................................................................................................
...........................................................................................................................................................................
7- O;olk; ,oe~ dk;kZy; dk irk@Occupation & Office Address:...................................................................
………………………………………………………………………………………………………...
8- nwjHkk’k la[;k (dk;kZy;)@Phone No. (Off.):………………………. fuokl (Residential):………………...
9- orZeku~ fu;kstd dk uke o irk@Name & Address of Present Employer:…………………………………
………………………………………………………………………………………………………………...
10- “kSf{kd ;ksX;rk@Educational Qualification:………………………………………………………………...
11- Hkk’kk Kku (fy[kuk] i<+uk] cksyuk)@Language known (Writing. Reading, Speaking):…………………...
……………………………………………………………………………………………………………….
12- ukxfjd lqj{kk dk;ksZ esa iwoZ vuqHko (;fn gS)@Previous Experience in Civil Defence (If Any):…………..
……………………………………………………………………………………………………………….
13- D;k vkids ikl dksbZ okgu gS \@Do you have any vehicle ?:…………………………………………….
14- D;k vki izkFkfed lgk;rk@okgu pykuk tkurs gSa \@Do you know driving ?:…………………………
15- rduhdh “kS{kf.kd ;ksX;rk@Technical Qualification:………………………………………………………
16- ernkrk igpku i=@vk/kkj dkMZ@ikliksVZ@MªkbZfoax ykbZlsal@cSad ikl cqd@vU; dksbZ ljdkjh QksVks
igpku i= dk fooj.k@Election I-Card/Aadhaar Card/Passport/Driving Licenses/Bank Pass Book/any
other employment Identity Card issued by Govt. Authority, with a photograph, Details:………………….
……………………………………………………………………………………………………………….
17- D;k vki dHkh gksexkM+Z ds lnL; jgs gSa \ ;fn gk rks fooj.k nsa@Whether you are a member of H.G.
earlier? If yes, Please give details:…………………………………………………………………………...
18- vH;FkhZ dk jDr lewg@Blood group of Applicant:………………………………………………………...
19- D;k vki fu;fer jDrnku djrs gSa \@Are you a regular Blood donor?:………………………………….
20- vfrfjDr lwpuk,sa@Additional informations:-
1- yEckbZ@Height :…………………………………..
2- otu@Weight :…………………………………..
3- vk/kkj la[;k@Aadhaar No. : …………………………………. (vkosnd ds gLrk{kj)
(Signature of Applicant)