Guide

Download as pdf or txt
Download as pdf or txt
You are on page 1of 3

Annexure-I

EAST COAST RAILWAY


APPLICATION FORM (in A4 size paper)
E.N.No. ECoR /Pers/S&G/2023-24 dated 01.02.2024
Application for Recruitment against Scouts & Guides Quota 2023-24

1. Candidate’s full name (in capital letters):


Paste (do not pin or
staple) your recent
(not older than
2. Father’s/ Husband’s name (in capital letters): three months)
passport size colour
photograph.
(Not to be attested)
Group-C (OR)
3. Post applied for:
Erstwhile Gr.D
D D M M Y Y Y Y 6. Sex:
4. Date 5. Community
(Male
of Birth: (SC/ST/OBC/UR)
/Female)
7. Educational
8. Religion 9. Nationality:
qualification:

10. Tick (√ ) the Serving Railway Divorcee/ Minority Economically Weaker Residents of Jammu &
applicable box, if Employee Widow Community Section Kashmir
you are:

11. Full address for correspondence


12. Mobile number:

13. E-Mail ID:

14. Nearest Railway Station

15. Scout/Guide District

State: PIN
16. Exam Fee Details: 17. Left Hand Thumb Impression.
DD/IPO No./Date Amount (Rs.)

18. Write 2 (two) clear visible marks of 1)


identification on your body. (Moles, Cut-
marks or scar marks etc.) 2)

19. Member of the Group for at least 5 years in the recent past:
Year Name of the Group Position held/Rank Date Warrant No. (If any) and
From To date
2019
2020
2021
2022
2023
Photocopy of the certificates regarding activities for last 5 years in recent past to be attached duly certified by the State/District
Commissioner (Scouts) for Scout wing and State/District Commissioner (Guides) for Guides wing./ Active membership certificate
should be furnished in Annexure-III.
…………………………………………………………………
20. Applicant’s full signature in running script (in Hindi or English)

Page1 of 3
APPLICATION FORM : E.N.No. ECoR /Pers/S&G/2023-24 dated 01.02.02024 Annexure-II

21. Particulars regarding Participation/Service rendered in National events/National Jomboree (including All Indian
Railway Events)
Sl. Event Certificate No. Date of Issue Issued by
No.
1
2
3
4
5
6
7

22. Particulars regarding Participation/Service rendered in State events/Rallies:


Sl. Event Certificate No. Date of Issue Issued by
No.
1
2
3
4
5
6
7

23. Particulars regarding Specialized Scout/Guide course organized at National/State/All Indian Railway level :
Sl. Event Certificate No. Date of Issue Issued by
No.
1
2
3
4
5

24. Particulars regarding Participation in District Rallies :


Sl. Event Certificate No. Date of Issue Issued by
No.
1
2
3
4
5

25. Applicant’s DECLARATION.


Copy the following paragraph in the space below in your own handwriting in running script (not in capital/spaced out
letters). Applications without this written declaration will be rejected:

“I hereby declare that all the statement made in the application are true, complete and correct to the best of my knowledge and
belief. In the event of any information being false or incorrect or myself being not eligible in terms of eligibility criteria, my
candidature/ appointment is liable to be cancelled/terminated without any notice at any stage even after empanelment”.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

26. Place:
27. Date: 28. Applicant’s full signature in running script (in Hindi or English)

Page2 of 3
APPLICATION FORM : E.N.No. ECoR /Pers/S&G/2023-24 dated 01.02.2024 Annexure-III

Certificate No ………………………….

CERTIFICATE OF ACTIVENESS

This is to certify that Shri/Ms……………………..………………………………… of ………....……………. ………….

…………………………… State/District/Division is an active member of ……………………………………Group since

………………………years duly registered with the State/District Association.

Date:

Seal and Office Stamp

(Name & Sign) (Name & Sign) (Name & Sign)


Group Leader(S/G) DOC(S/G) DC(S/G)

Page3 of 3

You might also like