Application Form Get
Application Form Get
Last Name:
E-mail :
(Active for the next 06 months)
(B) Nearest Railway Station/Bus Stand from mailing address mentioned above:
State:
8. Father’s/Husband’s Name:
General SC ST SEBC
(Candidates belong to SC/ST/SEBC categories must attach the attested copies of relevant certificate
issued by the Competent Authority)
11. Additional Information: (Please put a ‘√’ mark in the appropriate box)
12. Nationality:
Percentage
of marks up-to
Year &
Examination Name of the Course two decimal
Discipline/Subject Month of
Passed/Appeared Institute & University Duration points in
Passing aggregate
(In case of CGPA/Grades please give equivalent percentage (attach photocopies of the certificate and mark sheet
towards proof of essential qualification)
15. Educational Qualifications:
10th/HSC
(In case of CGPA/Grades please give equivalent percentage (attach photocopies of the certificate and mark sheet
towards proof of educational qualification)
Duration Gross
Sl. Employers Name & (DD/MM/YYYY) Post Held/ Nature of Duties/ Work Annual Pay
No. Address Designation Details Emoluments Scale
From To (in Lacs)
Date Date
18. Particulars of Demand Draft: (SC, ST and PwD candidates are exempted from the payment of fees)
Name and Address of Issuing Bank Date of Issue Amount (Rs.) Demand Draft No.
I hereby declare that I have carefully r ead t he condit ion s of eligibility ment ioned in the
advertis ement. T hese conditions are acceptable to me & I f ulfil the se con d itio ns. I hereby
declare that a ll statements made in this applicat ion are true, co mplete and correct t o t he
best of my knowledge and be lief and nothing has been con cealed there in. I shall fur nis h
the necessary cert ifi cate s in proof of t he above along wit h t he applicat ion . I understan d
that in the event of any informat ion bein g fo un d f alse at any st age or not sat isfy ing t he
elig ib ility criter ia accord ing to th e requirement s of the post , my can dida ture/
appoint ment is liable to be cancelle d/terminated .
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