APPLICATION FORMAT
All fields are mandatory.
3. Gender
4. Father’s Name
5. Mother’s Name
City:
State:
Phone No. (with STD Code) Phone No (with STD Code):
Mobile No.: Email ID:
- -
8. Date of Birth
d d m m y y
10. Nationality
Yes/No
19. Details of Training Undergone for more than 3 months, if any ………………..
Duration
Sl. Institute/
Name of the Programme From date – to
No. Organisation
Date
20. Experience : (chronological order from the first job to the current job) :
Central Date
Sl. Govt./State Pay Gross Reason for
Designation Organisation From To
No. Govt./PSU/ Scale Pay Leaving
(dd/mm/ (dd/mm/
Private
yy) yy)
21. Present Scale of Pay ________________ : Basic Pay _____________________
DA_________ Gross Pay __________
25. Pen picture of professional experience, achievements and significant contribution in the
field, if any
I hereby declare that the above statements are true and complete to the best of my
knowledge and belief. In the event, the information is found to be false or incorrect, my
candidature/ appointment considered may be terminated without any notice.
Place :
Signature of the Candidate
Date :