01. a) Name of the post : Upload Photo
(.JPG, .PNG, GIF)
02. b) Post No :
c) Category for which applied for :
Application Fee : Rs.  Bank  Date 
03.
04.
05.
Date of Birth in Christian era (DD/MM/YY) :
(In figures and words) :
Age as on :
Years : Months : Days :
06.
Male/Female : Male Female
07.
Marital Status : Married Unmarried
08.
Are you a citizen of India? Yes No
09.
Religion : 10. Community :
11.
Caste : Sub-Caste :
12.
Whether PWD : Yes No 13. Whether Ex-servicemen Yes No
14.
Identification Marks :
a)
b)
C)
15. Permanent address (in block letters) with PIN Code :
PIN Code :
16. Mailing address (in block letters) with PIN Code :
PIN Code :
17. Educational qualifications from Matriculation / Xth Std onwards (Duly attested Photo copies of certificates to be enclosed) :
Sl No. Qualifications University / Board Subject studied % of marks Obtain Remarks
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)

18. Technical /Other qualifications (if any) (Duly attested Photo copies of certificates to be enclosed) :
Sl No. Qualifications University / Board Subject studied % of marks Obtain Remarks
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)

19. Experience (if any) Particular of previous & present employment:(Duly attested Photo copies of certificates to be enclosed) :
Sl No. Name and full address of employer Designation / duties of post Scale of pay Period of Employment
From To
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)

20. Language Known :
i To Speak :
ii To Write :
iii To Read :
21.
Tel: Landline : Mobile :
22.
Email id (if any) :
23.
Additional Information, if any :
DECLARATION
I, hereby declare that the information furnished in the application are true, complete and
correct to the best of my knowledge and belief. I am fully aware that in the event of any of the said
information furnished by me being found false or incorrect at any stage, my candidature/appointment
is liable to be summarily cancelled/terminated without any notice or compensation.
 
Place : Signature of the candidate :
Date : Name :