Sd/-
Judge, Family Court, Rayagada
FORMAT OF APPLICATION FOR THE POST OF COUNSELLOR
1. Name of the Candidate:…………………………………………………………………………
………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
Name of the Name of the Year of Passing Marks Grade /Division % of marks
Examination Board/University secured/Aggregate (if any) secured
Passed Marks
9. Religion: ………………………….
10. Nationality: …………………………
11. Experience in the field of Family Counseling,
(Details with self attested copy of experience certificate): ………………………………………………………….
12. Mobile number & E-mail ID (if any) of the Applicant: …………………………………………………………….
DECLARATION
I do hereby solemnly affirm and state that the statements made above are true and correct to
the best of my knowledge and belief. Any information, if found false/incorrect/incomplete in any
respect, shall entail summary rejection of my candidature.
Date:-
Place: - Signature of the Candidate.
List of Documents Enclosed:-
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