APPLICATION FORMAT

(a) Name of the Post :

(b) Employment Notification No. & Date :

(c) Name :

(d) Father’s / Husband’s Name :

(e) Address :
(i)Permanent :

(ii)Correspondence :

(f) Phone / Mobile No. :

(g) Email ID :

(h) Age and Date of Birth :

(with supporting document)

(i) Religion :

(j) Caste (Genl. / SC / ST / OBC) :

(Certificate in case of SC/ST/OBC)

(k) Physically Handicapped / :

(Certificate to be enclosed)

(l) Married or Single :

(m) Educational Qualifications :

(Documents to be enclosed)

Name of the Exam University/ Year of Class/Div. Grade Subjects taken

College/School Passing with percentage of
marks

(*) In case of private institution, it to be mentioned whether the course is recognized /

affiliated by Govt. etc.

Contd……P/2
 :: 2 ::

(n) Experiences :
(Documents to be enclosed)
Name of the From To Designa- Salary Nature Reason
Sl. Organization tion of for
No. Duties leaving
*Basic + Scale
allowances

* Candidates working in Central Govt. / State Govt. / State Govt. / PSUs /

Autonomous body should mention last pay scale drawn indicating structure of pay pattern
i.e.CDA/IDA/State DA pattern.

(o) Whether earlier appeared for interview for

any post in GRSE. If so, details thereof :

(p) Joining Time Required :

(q) Any other relevant information :

(r) Detail of Postal Order / Bank Draft :

____________
Date : Signature

Place :