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Standard Form of Application

This document contains a standard application form for a government position in Assam, India. The form requests information such as the applicant's name, address, citizenship status, educational background, age, previous employment history, and other personal details. It informs the applicant that providing false information could result in penalties and that a treasury challan receipt must be attached with the application.

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Tuki Das
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Download as PDF, TXT or read online on Scribd
2K views

Standard Form of Application

This document contains a standard application form for a government position in Assam, India. The form requests information such as the applicant's name, address, citizenship status, educational background, age, previous employment history, and other personal details. It informs the applicant that providing false information could result in penalties and that a treasury challan receipt must be attached with the application.

Uploaded by

Tuki Das
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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ASSAM GAZETTE (PART -IX)

STANDARD FORM OF APPLICATION


To, PHOTO
The ………………………………………………………………………………………………………………………
Name of the Post ………………………………………………………………………………………………..
Department/Office ……………………………………………………………………………………………..

1. Name in Full (Block letter) : …………………………………………………………..………………………………..


2. Present Address : ……………………………………………Vill/Town………………………………..
…………………………………………………………………………………………….
3. Permanent Address : …………………………………………… Vill/Town……………………………….
……………………………………………………………………………………………..
4. Father’s Name & Address : …………………………………………………………………………………………….
5. Place of birth including Police Station and : …………………………………………………………………………………………….
District & P.O …………………………………………………………………………………………….
6. Are you a citizen of india and if so how? (Copy of citizenship certificate should be enclosed
where necessary ) : …………………………………………………………………………………………….
7. Educational qualification and also the : …………………………………………………………………………………………….
name and full address …………………………………………………………………………………………….
8. Other Qualifications : …………………………………………………………………………………………….
9. Community : …………………………………………………………………………………………….
(a) State your religion : ……………………………………………………………………………………………
(b) Are you a member of Schedule : ……………………………………………………………………………………………
Caste/Schedule Tribe
(Answer ‘Yes’ or ‘No’) If ‘Yes’ give particulars supported by a certificate copy of which should be enclosed.
10. Age on the 1st January 20…. (According to H.S.L.C certificate copy of which should be enclosed)
: …………………………………………………………………………………………..
11. Present occupation (if any) : …………………………………………………………………………………………..
12. Previous appointment held (if any) : …………………………………………………………………………………………..
13. Are you a temporary or retrenched personal of Temporary Departmental of the Govt. of Assam
(Answer ‘Yes’ or ‘No’) State particulars : …………………………………………………………………………………………..
14. Are you trained in or a member of the National Cade Crops of Territorial Army or trained Home Guards and
Civil Defence Volunteers, if so give particulars.
: ………………………………………………………………………………………….
15. Employment Registration No. : ………………………………………………………………………………………….
16. Whether there is any Govt./Semi Govt. Employees in your family if any, Particulars of such family member like
relationship, name of the job, pay drawn, place of posting, permanent /Temporary etc. should be furnished.
: …………………………………………………………………………………………
………………………………………………………………………………………….
17. Family’s income certificate from the : ………………………………………………………………………………………….
Gaon Panchayat /DC/SDO/Circle Officer to be furnished
18. Examination Centre : ………………………………………………………………………………………….

I am a candidate for the post ……………………………………………….. and the stated above are true to the best of my
knowledge and behalf. In case of any false statement, I am liable to any action the Government deem fit and
proper.
A treasury challan of Rs ……………………… is attached herewith.

19. To be filled in by Candidate


Date: …………………………………
Place: ……………………………….. Signature of Candidate

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