[PDF] APPLICATION FORM Candidates applying for more than





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Annexure 1 APPLICATION FORM Personal Details [IN CAPITAL

APPLICATION FORM. Advertisement No. Please affix. Recent Passport size photo. Name of the Department / Speciality. Applied for. Name of the Post.

APPLICATION FORM

Post Applied for :____________________

1. Full Name : ______________________________________________

2. Father's Name :______________________________________________

3. Permanent Address : ______________________________________________

4. Address for Correspondence /

Present Address : _____________________________________________

5. Date of Birth : ________________ 6. Sex : Male : Female :

7. Religion : ___________________ 8. Nationality : ____________________________________

9. Domicile : __________________ 10. Category:

(State)

11. Ex-Serviceman

Date of Joining Service : ______________________________ Date of Discharge from Service : ______________________________

12. E-mail id : ____________________________

13. Telephone No. (With Std Code) : ____________________________

14. Mobile No. (If any) : ____________________________

SC ST OBC EXSM PH

Affix recent passport

size photograph

Identity should be

certified by an officer as mentioned in the advertisement with designation / seal of office.

15. Educational Qualification :

Qualification Subjects Percentage of

marks Year of Passing

Principal Subsidiary

16. Experience :

Name of the

Organisation Designation Nature of duties Period Duration.

From To

17. If employed in Govt. Dept. / PSU, whether applied through proper channel : Yes / No.

18. DD No. __________ Date.___________________ Name of Issuing Branch _____________

Branch Code No. __________________.

Declaration : I hereby declare that all statements made in the application are true, complete and correct to

the best of my knowledge and belief. I also undertake that I have not submitted applications for two

different posts advertised. The relevant clause is stated below for easy reference :- "Candidates can

apply against any one post only. Candidates applying for more than one post will not be considered and

such applications will be rejected." I understand that in the event of any information being found untrue /

false / incorrect or I do not satisfy the eligibility criteria, my candidature / appointment will be cancelled /

terminated, without assigning any reasons thereof. I have read the contents of the advertisement and

agree to abide by the rules, regulations and procedures for appointment to the post applied for.

Date :

Place : (Signature of Applicant)

IDENTITY CERTIFICATE

This is to certify that the details and photograph of Shri _________________________ S/o._________________________________________________ and resident of (R/O) who has applied for the post of __________________________________________ is verified and certified as correct and genuine.

PERMANENT ADDRESS :

PRESENT ADDRESS :

Signature of the Candidate : ______________________________ Signature of the Certifying Officer: ______________________________ Name of Certifying Officer : ______________________________ Phone No. of Certifying Officer : ______________________________ Designation : ______________________________ (Seal of Office ) [Note : Identity of the Candidate should be certified by an Officer not below the rank of Tehsildar / Sub-Divisional Officer of the candidate's domicile place / native place, Principal of the school / college from where the candidate has passed his 10 th

Standard, Intermediate

or Graduation / Diploma along with name, designation and seal of office.]

Affix photograph

Seal of office & Signature of the

officer attesting this certificate should appear on the

Photograph.

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