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mridc_application_form_gen_01_09_23

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अमित बापु हांडे
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88 views4 pages

mridc_application_form_gen_01_09_23

T

Uploaded by

अमित बापु हांडे
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
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APPLICATION FORM

Photographs
should be

self-attested

1. Name of the Post applied for :

2. Name of the
PresentOrganization:

3. Present Designation:

4. Candidate’s Name (in capital letters) (Please keep one box blank
betweenname, middle name & surname) :

5. Father’s / Husband’s name (in capital letters) (Please keep one box blank
between name, middle name & surname) :

6. Date of Birth : Day Month Year

7. Educational Qualification (Academic & Professional) possessed by the


officer:

Degree Institute Board / Maximum Year Marks %age of


University Marks of Obtained marks
Passin (up to 2
g decimal)
8. Details of employment in chronological order. Enclose a separate sheet
dulyauthenticated by your signature if the space below is insufficient.

Name Designatio Scal Period of Total Clearly indicatethe


and n e of Service Experien nature of
address Pay cein experience. Also
of From To years mention the name
employ of the project / unit
er where worked

9. Total emolument per

month: (Give break up)

10. Additional information, if any, which you would like to mention in


support of your suitability for the post. Amongst other things may provide
information with regard to (i) Additional academic qualifications (ii)
Professional training and (iii) Work experience with respect to job
description of the post advertised) (The details should not be in more than
200 words. Enclose a separate sheet, if the space is insufficient) :

11. Community :
SC ST OBC GEN OTHERS

12. Present Address (in capital letters)


13. Permanent Address (in capital Letters) :

14. Mobile No :

15. Email id :

16. References (Of 2 Senior Officers with whom you have worked for a
minimum of2 years or more) :

I II

Name
Design.
Organization
Mob
email

DECLARATION TO BE SIGNED BY THE


CANDIDATE

I hereby certify and declare that (i) I have carefully gone through the vacancy
circular / advertisement and I am well aware that the Curriculum Vitae duly
supported by documents submitted by me will also be assessed by the selection
Committee at the time of selection for the post, (ii) All statements made and
information given by me in this application are true, complete and correct to the
best of my knowledge and belief. In the event of any information or part of it being
found false or incorrect before or after the interview or appointment, criminal
action can be initiated against me by MRIDC and my candidature / appointment
shall automatically stand terminated, (iii) I further declare that I fulfil all the
conditions of eligibility prescribed for the post applied for. (iv) In case my
application is not received by MRIDC within the stipulated date due to postal
delay or otherwise, MRIDC will not be responsible for such delay.

19. List of Enclosures: (i) (ii)


(iii) (iv)
(v) (vi)

Place:

Date: (Signature of the Applicant)


I hereby certify that I do not have any Disciplinary case / Vigilance Case / Any case
arising out of SPE / CBI pending against me. I do not have any Criminal
Proceedings pending against me.
I further certify that I am not undergoing any punishment as on the date of this
application.

(Signature of the Applicant)

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