APPLICATION

Post Applied for_______________________________________

Employment New No___________ dated____________________
1. Name in Fill (Block letters)_______________________________
2. Father’s/Husband’s Name_______________________________
3. Nationality___________________________________________
4. Date of Birth__________________________________________
(Attested copies of School Certificate showing Date of birth must be enclosed)
5. Age on the last date of submission of Application____________________
6. Category (GEN/OBC/SC/ST)__________________________________
(Attach attested Photostat copies of caste certificated in case of reserved category)
7. Whether Ex-Servicemen_____________________________________
(Attested copies of Ex-Servicemen certificate issued by competent authority and discharge
certificates must be enclosed)
8. Whether person with disability, if so furnish details along with % of disability_____________
(Refer ix of SL.No.8 General Note in Advertisement)
9. Full address for communication__________________________________________________
10. Contact Phone No. ______________Mobile No. ____________________Email ID_________
11. a. Details of Educational and other qualification:-
Name of Name of Recognized
Year of %of marks
Exam Subject University/Board of Remarks
Passing obtained
passed Examination

(Attested copies of all Educational Qualification certificates to be enclosed)

b. Details of passing NCTVT/ITI or equivalent examination
Training
Name of the NCTVT Year of Marks
Trade Period Remarks
Institution Batch No. passing
From To Obtained Out of
(Attested copies of all Educational Qualification certificates to be enclosed)
12. Experience/if any_____________________________________________
13. Whether Government Servant_____________________________________
If in Government service, indicate: Name of the Department, Post held____________________
Date of entry in Service _____________________________________

Declaration by OBC Candidates

I__________________Son/daughter of Shri/Smt_____________________________ resident of

village/town/city____________________District_________________State_________________
Hereby declare that I belong to the ___________________community which is recognized as
Other Backward Class by Government of India for the Purpose of reservation in services as per
orders contained in the Department of Personnel and Training office Memorandum
No.3601/22/93-Estt (SCT) dated 08.09.1993. It is also declared that I do not belong to
persons/sections (creamy layer) mentioned in column 3 in the Schedule to the above referred
Office Memorandum dated 08.09.1993.

Signature of the Candidate

Declaration
I hereby declare that all the statements made in this application are true, complete, and correct
to the best of my knowledge and belief. In the event of any information being found
false/incorrect or ineligibility being detected before or after the written test/trade, test my
candidature will stand automatically cancelled.
(Signature of Candidate)
Name:
Place:
Date:

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