APPLICATION FORMAT 1. 2. 3. 4. +. .. /. 2. 5. Advertisement No. and Sl.No.

of the Post Post Applied for Name (in block letters) Cate or! ("eneral # SC # S$ # %&C # Ph!sicall! 'andicapped # ()*Servicemen) ,ate - Place of &irth Nationalit! 0arital Stat1s Address for Correspondence (3ith Phone No. and (mail 4,) Permanent Address

Affi) !o1r recent passport si<e photo raph here

16. Nearest 7ail3a! Station 11. 81alifications (SSC on3ards) ()am Passed &oard 9niversit! # Stream ,ate of release of 0ark sheet :ear Passin of ,ivision Percenta e of marks obtained

12. ;ork ()perience (in chronolo ical order startin from present position back3ards) Name of the ,esi nation Nat1re of 3ork Period or ani<ation in detail =rom $o (,,#00#::) (,,#00#::)

Scale of Pa! and total salar! dra3n per month

13. 'ave !o1 been called for intervie3 in past> 4f !es? provide details 14. 7eferences 1+. An! other relevant information 4 hereb! certif! that the fore* oin information is correct to the best of m! kno3led e and belief. 4 have not s1ppressed an! material fact or fact1al information in the above statement. 4n case 4 have iven 3ron information or s1ppressed an! material fact or fact1al information? then m! services are liable to be terminated 3itho1t ivin an! notice or reason thereof. 4 am not a3are of an! circ1mstances 3hich mi ht impair m! fitness for emplo!ment 1nder "overnment. 1.. Si nat1re 3ith ,ate