Store AP
Store AP
Space for
Passport Size
Photograph
Name of Candidate
(in Capital letters)
Day
2.
Date of Birth
3.
4.
Nationality
5.
Gender(Male/Female)
6.
Marital Status
Month
Year
22/05/2015
Married
Gen
7.
Age as on
Single
SC
ST
OBC
Category
(Please tick in appropriate box)
8.
Correspondence
Permanent
9.
Tel. No.
10.
Mobile No.
11.
E-mail Id.
12.
Sl.
No.
Educational Qualifications:-
a)
10th
b)
12th
c)
Graduation
B.A./B.Sc./B.Com
f)
Year of
passing
% of Marks
13
Sl.
No.
Work Experience (in chronological order beginning from the present job):Designation & Pay Scale
Organization
Period of service
From
To
Total Experience
Number of
Years/months
14. Present post with scale of pay & pay drawn: ....
15. Disclosure about past disciplinary proceedings, if any ............................................
.
16. Details regarding legal detention / conviction if any: ...
..
17. Any other information desired to be furnished: .
18. Whether the candidate is already in Govt. Service (Yes/No):- ..
19. Details of Application Fee:- Demand Draft No Date:- Amount:- .
Date:.
Place:
Declaration
I hereby declare that all the particulars furnished by me in this application are true to the best of
my knowledge and belief. If any of the information/particular furnished by me is found to be false at any
stage, I am aware that my candidature / selection is liable to be rejected / cancelled by the appropriate
authority without assigning any reason.
Name: