Application Form

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Last Date for Receipt of Application ______________

APPLICATION FORM (Through Proper Channel)

1. Name of the post applied for ___________________________


A recent passport
Advertisement No. ___________________________
size photograph
to be affixed in
2. Name ____________________________ this space.
(In Block Letters)
3. Postal Address ____________________________
____________________________
____________________________
4. Contact Number ____________________________
5. E-mail ID (if any) ____________________________

6. Date of Birth ___________________________

(in Christian Era)

7. Sex Male Female

8. Community (Whether SC/ST/OBC/Others) _____________________

9. Educational Qualifications (Starting from High School)

S.No. Examination Year of Name of the %age of marks Subjects


passed passing School/College obtained
/University

1
10. Experience

S. Name of Post Scale of Pay Name of the Period Nature


No. Department of work
From To

11. Training programme attended/participated _______________________


(Enclose self attested copies of certificates)

12. Details of Enclosures: ____________________________________

13. Choice of posting, if any (against available vacancies) ____________

I hereby declare that all statements made in this application are


true and complete to the best of my knowledge and belief. I understand that
action can be taken against me by the Council if I am declared to be guilty of
any type of misconduct mentioned herein. I have informed my Head
Office/Department in writing that I am applying for selection to the post on
deputation/foreign service basis.

Signature of the Candidate

Name ____________________

Date:

2
Place:

3
A Vigilance Clearance Certificate as given below should be given by the Department

Certified that Shri/Smt./Kumari/ ___________________________________________________ of


_________________________________________________________________________ holds a
temporary/permanent post of _________________________________________________ in the
Department of _____________________________________________________________ and that
no disciplinary case is pending or contemplated against him/her.

No. Signature ___________________


Date: Designation _________________
Office Seal __________________

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