Cement Corporation of India Limited
(A Govt. of India Undertaking) Please affix your recent
passport size photograph
Application Form
ADVT.No.CO/10/2024
Name of the post applied for
Post Code
To be filled in BLOCK LETTERS*
1. Name of the applicant*
2. Date of Birth (in DD/MM/YYYY format)
3. Age (Yrs & Month) as on last date of application
4. Category (Please tick one) SC
ST
OBC (Non creamy layer)
EWS
General
5. Whether differently abled (if Yes details) Yes Type:VH/HH/OH/others , %age_____
No
6. Sex (Please tick one) Female
Male
7. Nationality*
8. Present Employment Status (Please tick one) Public Sector
Government
Private Sector
Not working
Autonomous
9. Adhaar No.
10. Grounds for claiming age relaxation*
11. Educational & Professional Qualifications (Only Graduation & above, mandatory to be written first)
Qualification College/Institution University Year of Class/Div % age of Subjects/ Core
Passing ision marks discipline
obtained
12. Total Experience (After the requisite qualification acquired) : Years Months
13. Details of present employer: (Please use additional sheet, if required)
Employer’s name Location of Period of Designation Type of Brief nature of
posting Employment held employement duties/Functions
(Adhoc/Contract/
From To Training/Regular)
-2-
14. Details of post qualification experience other than at SN-13. Please give details of different positions held in each
Organization with dates. Training period if any, may be mentioned separately:(Please use additional sheet, if required)
Employer’s name Location of Period of Designation Type of Brief nature of Reasons
posting Employment held employement duties/Functions for leaving
(Adhoc/Contract/
From To Training/Regular)
15. Details* of Pay Scale/ CTC being drawn in the present post as on the date of application:-
Scale of pay Date of entry Basic pay Perks/Special Other Total monthly Cost to
in the scale Pay, if any emoluments emoluments Company
(Annual)
16 Mailing Address*
District : State :
Pincode:
17 Land line Telephone No. Mobile No.
18 E-Mail
19. Details of DEMAND DRAFT enclosed with this aaplication form:
Demand Draft No. Date on which issued Issuing Bank Amount (in ₹)
Please tick the applicable as below:
20 Have you ever been arrested in a criminal case or convicted, fined or imprisoned for Yes*/No
violation of any law (excluding minor traffic violation)
21 Whether any punishment/penalty was awarded to you or any vigilance case ending as far as Yes*/No
your knowledge goes
22 Have you applied before for employment in CCI Ltd ? Yes*/No
23 Are you in a Government / Semi-Govt. / Public SectorUndertaking / Autonomous body Yes/No
other than Cement Corporation of India Limited?
24 Do you possess the essential educational qualifications as required for the post applied for? Yes/No
*If “Yes” give details
I certify that the information furnished above is correct to the best of my knowledge and as per the advertisement I am eligible
to be considered for shortlisting for interview. I undertake that this employment is purely based on Fixed Term Contractual basis
and hence I shall not claim regular employment in future. I understand that if the information is not correct, or not supported by
documentary proof, my candidature will not be considered, even after shortlisting.I understand that my candidature is subject to
the conditions laid down in the detailed Advertisement No. CO/10/2024 on CCI website. I further declare that, I have never been
debarred from applying for any Government job.
Date: Signature of Applicant
Place:
