Form Director Balbhawan

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5- orZeku ewy osru ,oa osrueku


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11. fiNys nl o’kksZa esa /kkfjr inksa dk fooj.k Øe ls :

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Annexure-I

APPLICATION FOR THE POST OF DIRECTOR ON DEPUTATION BASIS

Affix
Recent
Photo

1. Name (IN BLOCK LETTERS): _________________________________

2. Date of Birth: _________________________________

3. Age as on last date of


submission of application: _________________________________

4. Date of superannuation
from the present service _________________________________

5. Present basic pay and _________________________________


scale of pay: _________________________________

_________________________________

6. Correspondence address: _________________________________

_________________________________

_________________________________

7. Mobile No. _________________________________

8. Name & address of the _________________________________


Organization where
presently working. _________________________________

_________________________________

9. Educational Qualification _________________________________

10. Date of entry in Govt.Service ________________________________


11. Posts held during last 10 years (in chronological order)

S. Post held Name and Period Pay Scale Nature of duties


No. Address of From To with performed
Organization break up

DECLARATION

I solemnly declare that the details given above in the application


form are correct to the best of my knowledge and belief. In case any of
the details in the application from are found false at a later stage, my
candidature / appointment may be cancelled / withdrawn.

(Signature of the Candidate)


Date: ________________
Place: _______________

(FOR USE OF FORWARDING OFFICE)

It is certified that the details provided by the applicant as above


are correct as per our records. No vigilance / disciplinary case is
pending / contemplated against Shri / Smt. / Ms.
__________________________. If selected, the individual will be relieved
immediately.

2. Gist of his/her preceding 05 years ACR/APRs is as under:

S. No. Year Grading / Marks

(Signature of the forwarding officer)


Name _______________________________
Date:________________ Designation ________________________
Place:_______________ Seal of the Office__________________

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