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Advertisement No.: Amd-1/2015: Affix Latest Passport Size Photo

This document appears to be an application form for a position with the Government of India Department of Atomic Energy, Atomic Minerals Directorate for Exploration & Research. The multi-page form requests personal details from the applicant such as name, date of birth, address, education history, employment experience, and references. It also contains checkboxes for the applicant to ensure all required documents are included with the application. If selected, the applicant agrees to abide by the conditions in the advertised post.

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Jeshi
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107 views3 pages

Advertisement No.: Amd-1/2015: Affix Latest Passport Size Photo

This document appears to be an application form for a position with the Government of India Department of Atomic Energy, Atomic Minerals Directorate for Exploration & Research. The multi-page form requests personal details from the applicant such as name, date of birth, address, education history, employment experience, and references. It also contains checkboxes for the applicant to ensure all required documents are included with the application. If selected, the applicant agrees to abide by the conditions in the advertised post.

Uploaded by

Jeshi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Government of India

Department of Atomic Energy


Atomic Minerals Directorate for Exploration & Research
Begumpet, Hyderabad 500 016.

Affix Latest Passport


size Photo

ADVERTISEMENT NO.: AMD-1/2015


Application for the post of _________________________________
(For office use only)
Application No.

Examination Centre

Roll No.

1.

Full Name ( BLOCK LETTERS)


(As per SSC Certificate)

2.

Father/Husband/Guardians Name

3.

Date of Birth
(in Christian Era)

4.

Age as on 10-08-2015

5.

Sex

Male

6.

Marital Status

MARRIED / SINGLE / WIDOWER / WIDOW

7.

Religion

8.

Whether the applicant belongs to


GENERAL/SC/ST/OBC.

Female

If belongs to SC/ST/OBC please state


the name of Caste
9.

Present complete Postal Address in


BLOCK LETTERS with State, Pin Code,
Telephone No. with STD code etc.

10.

Permanent Postal Address in BLOCK


LETTERS with State, Pin Code,
Telephone No. with STD code etc.

11.

Nationality

12.

Indicate the percentage and type of


disability
and
enclose
relevant
certificate.

13.

Whether Ex-Serviceman?

YES / NO
(If yes enclose relevant certificate)

14.

Are you domiciled in Jammu &


Kashmir during the period from
1-1-1980 to 31-12-1989?

YES / NO
(If yes enclose relevant certificate)

: 2 :
15

Are you a family member of those


who died in 1984 Riots?

16.

Are you under any contractual


obligation to serve the Central / State
Government /any other Public Sector
Undertaking? If so, please furnish full
details.

YES / NO
(If yes enclose relevant certificate)

17. Details of relatives, if any employed in the DAE or its Constituent Units and relationship
Name of Relative

Relationship

Unit
in
employed

which

Post held

18. Educational/Technical Qualifications beginning with SSC:


Examination
Passed

19.

Subjects

Board / University

Year of
passing

Percentage
Of marks

Class
obtained

Experience particulars of previous and present employment are to be furnished

Post held

Name
of
employer with
full address

Period
From

To

20. Are you in receipt of any Pension, gratuity


or employers share of contribution of Provident
Fund from the Central/State Govt. or any Public
Sector Undertaking?
If so, please give
particulars thereof.
21.
Full Postal Address of a District level
Government Hospital nearest to your Place of
residence.

Nature
of
duties / work

Reasons
leaving

for

: 3 :
DECLARATION
1. I hereby declare that the above information is factually correct to the best of my
knowledge and belief.
2. I am aware that my application is liable to be rejected if the information given is
incomplete or found to be incorrect.
3. I understand that in the event of any information being found false or incorrect at any
stage or not satisfying the eligibility conditions according to the requirements mentioned in
the advertisement, my candidature / appointment is liable to be cancelled/terminated.
4. I undertake to abide by all the conditions specified in the advertisement.
Place:
Date :
Signature of the Candidate
Mobile No. (if any) :
E-mail ID (if any) :
Check list for candidates
(put a tick ( ) in the applicable box
1.

Application duly completed and signed.

2.

Photograph affixed and one extra photo attached

3.

Date of Birth certificate

4.

Caste Certificate

5.

Attested Xerox copies of educational/technical qualification certificates

6.

Experience Certificate if any,

7.

No objection certificate from employer(in case of in-service personnel)

Residential proof certificate

Discharge Certificate from Defence Services (if applicable)

10

Disability Certificate issued by Medical Board

Signature of the Candidate

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