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Application Form

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19 views5 pages

Application Form

Uploaded by

apsarasamanmali149
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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Employees Trust Fund Board

Application Form

Application for the post of …………………………………………………………………………………………………

01' Personal Information

Status Dr. Mr. Mrs. Miss.

Name in Full
(in English Block
Letters)

Name with Initials


(in English Block
Letters)

Permanent Address
(in English Block
Letters)

Province District

E-mail Telephone
Address
NIC No Gender

Civil Status

Date of Birth Date Month Year Age as at Closing date Date Month Year
02' Educational Qualifications (Attach Copies of Certificates)
I. G.C.E.(Ordinary Level) Index No
Examination year

No Subject Grade No Subject Grade

II. G.C.E.(Advance Level) Index No


Examination year
Stream

No Subject Grade No Subject Grade

03' Academic Qualifications (Attach Copies of Certificates)

University/ Period Major Field Degree Class- if any Year


Institution
04' Professional Qualifications (Attach Copies of Certificates)
Institution Period Field of Study Qualifications Year

05' Language Proficiency:


Language Proficiency Give the qualification if any
Fluent/ Very good/ Good/
Poor

06' Employment Record: (Attach Service Certificates)

Place of Work Position From To Period


07' Any other Extra Curricular Activities:

Event National/ District/ Interschool/ School Level

08' Two Non – Related Referees


Name Position Address Telephone No

09' Declaration of the Applicant


I respectfully declare that the particulars furnished by me in this application are true and correct
to the best of my knowledge. I agree to bear the loss which may occur due to incomplete and / or
incorrect completion of my part of this application. Further, I state that, all sections of this
application completed are true and correct to the best of my knowledge.
I shall not subsequently change any information stated above.

Date ……………………….. Signature of application ………………………


10' Attestation
I do hereby certify that Dr./Mr./ Mrs./ Miss. ……………………………………………………...
……………………………………………………………………… is personally known to me
and placed his/ her signature in my presence on …………………………………………

11' (The part is Applicable only for Candidates who Engage in Government
Employment) Attestation of the head of the Department / Institution
I hereby certify that Dr./Mr./ Mrs./ Miss. ………………………………………………………….
who is working in this ministry/ Department/ Institution, is working in the post of ………………
…………………………………………………………………………………. and his/ her work
and conduct are satisfactory, no disciplinary action pending against him/ her and no decision has
been taken to impose any such in the future. If he/ she will be selected for this post, he/ she can/
cannot be released from the service.

Date ……………………….. ………………………………………


Signature of the head of the
department/ Authorized officer
Name ……………………………………

Designation ……………………………………

Address …………………………………………………………………………………….

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