Page 1 of 2 RAILWAY RECRUITMENT CELL, EAST COAST RAILWAY

APPLICATION FORM ( in A4 size paper ) For office use only

To
Dy.Chief Personnel Officer(Recruitment), Control Number
Railway Recruitment Cell, East Coast Railway Headquarters,
Roll Number
C-57/G, Rail Vihar, Chandrasekarpur, Bhubaneswar-751023

(Note: Application to be filled by the candidate in own handwriting using black ink ball point pen. All Columns are to
be filled compulsorily by all applicants, except columns 6, 7 & 10 by the relevant candidates only.)
Sub: Application for recruitment to Group-D posts in ECoR notified in Employment Notice No. ECoR/RRC/D/2006/01
I do hereby apply for recruitment to group-D vacancies mentioned in the above notification in East Coast
Railway and furnish the following particulars:
1. Full Name of the Candidate (in capital letters as it appears in school certificate):

2. Two marks of (i) (ii)

physical identification:
Category 4. Priority of Recruitment
3. Priority
Code Division/Workshop Unit Code
of Category
Priority 1st 2nd for appointment Priority 1st 2nd 3rd 4th

5. Medium of written examination Language Oriya Telugu Hindi English

question paper (tick one medium): ( ) ( ) ( ) ( ) ( )

6. For serving Railway employees (Certificate in proof of status to be furnished for availing age relaxation):
Designation Department / Railway office with address Number of years of service

7. For Ex-Servicemen [ONLY those who did not yet avail government employment under ex.servicemen quota]
(Certificate in proof to be furnished for availing age relaxation & ex.servicemen quota vacancies):
Enrolment Attestation State unit with address Discharge / Length of Service
date date Retirement date (Years, Months)

8. List of Enclosures (as applicable and explained in the instructions):

a. b. c.
d. e. f.

9. Full Sample signatures in running script in English or Hindi:

(i) ___________________________________ (ii)____________________________________

10. Examination Fees Paid through ( ) DD ( ) Pay order ( ) IPO ( )

Bank / P.O name/ location DD / Pay Order / IPO No. Date Amount (Rs.)

11. Left thumb impression of the candidate (After applying ink on the left thumb once, three impressions are to be
made one after the other in the three boxes without applying ink once again. Impressions should not be smudged.)

12. Place: 14. Applicant’s full signature

13. Date: (in English or Hindi in running script)
Page 2 of 2 RAILWAY RECRUITMENT CELL, EAST COAST RAILWAY
Roll Number (for office use only) PERSONAL DATA SHEET (in A4 size paper) Control number (for office use only)

Employment Notice No. ECoR /RRC /D /2006/01

[To be filled by the candidate in own handwriting using black ink ball point pen. Tick ( ) wherever required.
All Columns are to be filled compulsorily, except column 12 by relevant candidates only.]
Affix your recent passport
1. Full Name of the Candidate (as it appears in school certificate): size black & white photo,
not older than one month
as on date of application.
Photo to be sharp & clear,
with light background,
suitable for scanning and
2. Father / Husband Name: printing. Photo to be in
4cm x 5cm size. Photo to
be pasted firmly.
Do NOT staple or pin it.
Do NOT attest this photo.

3. Sex: ( ): Male ( ) Female ( )

4. Nationality:
Applicant’s full signature in English or
Hindi in running script in the above box
5. Full Mailing Address for Correspondence: 6. Full Permanent Address:

State: State:
PIN PIN

7. State of 8. Nearest Railway

Domicile Code: Station:

9. Date of d d m m y y y y 10. Education

Birth : Qualification :

11. Community UR SC ST OBC 12.Tick ( ) Divorcee Widow

( ): ( ) ( ) ( ) ( ) if you are : ( ) ( )

13. Religion Hindu Muslim Christian Sikh Buddhist Jain Parsi Others
( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( )
14. Declaration: “I hereby declare that the facts and evidences given by me in the Application Form and Personal
Data Sheet are true, complete and correct to the best of my knowledge and belief. In the event of any discrepancy in
the particulars or any statement being found false at any stage, my candidature / service would be cancelled /
terminated without any notice.” (Above declaration is to be written below in the applicant’s own running script in
English):
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________

15. Place: ____________________________________________________

16. Date: 17. Applicant’s full signature (in English or Hindi in running script)