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Standard Form of Application: Assam (Gazette Part-Ix)

This document contains a standard application form for a government post in Assam, India. It requests information such as the applicant's name, address, citizenship status, educational qualifications, employment history, age, family details, and examination center. The applicant confirms that the facts provided are true to the best of their knowledge and that they are liable for any false statements. A treasury challan receipt for the application fee is also to be attached.

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achyutborah
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13 views

Standard Form of Application: Assam (Gazette Part-Ix)

This document contains a standard application form for a government post in Assam, India. It requests information such as the applicant's name, address, citizenship status, educational qualifications, employment history, age, family details, and examination center. The applicant confirms that the facts provided are true to the best of their knowledge and that they are liable for any false statements. A treasury challan receipt for the application fee is also to be attached.

Uploaded by

achyutborah
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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ASSAM (GAZETTE PART-IX)

STANDARD FORM OF APPLICATION


To

........

Name of Post
..........................
Department/Office...
1) Name in full (Block letters):
...................................................
2) Present Address
Vill/Town............................
P.O..P.S........................
3) Fathers Name & Address
..........................
..........................
..........................
4) Place of birth including Police Station &P.O
.............................
5) Are you a citizen of India & if so how?
............................
(Copy of citizenship certificate should be enclosed where necessary)
6) Educational qualification & also the name & full add of the institute in which read last
(Copies of certificate should be enclosed)
.............................
Exam passed

Name of the
board/Council/
University

Year of
Exam

Roll No

Division/
Class

Name of the
Institution

7).Other qualification:
....................................
8) a. Community: ..
b. Are you a member of Scheduled Cast/Scheduled Tribe (Answer yes or no)? If yes give
Particulars supported by a certificate copy of which should be enclosed.
.............................

9) (a) Age on the 1st January199_ /201_(According to HSLC certificate copy of which should be
enclosed).............................
(b) Exact age on date of the application .
10) Present occupation (if any)...
11) Previous appointment held, (if any)..
12) Are you a temporary or retrenched personal of temporary Department of the Govt. of Assam
(Answer yes or no, state particulars)
............................
13) Are you trained in or a member of the N.C.C. or Territorial army or trained Home guards and Civil
Defense volunteers? If so give particulars:
.............................
14) Employment Exchange Registration No.
.................................
15) Whether there is any Govt./ Semi Govt Employees in your family ? If any, particulars of such
family like relationship, name of the job, pay drawn, place of posting, permanent/temporary etc
should be furnished.
..................................
.............................
.............................
16) Familys income certificate from the Gaon Panchayat/DC/SDO/Circle Officer to be furnished
.................................................
.................................................................
17) Examination Centre
..................................

I am a candidate for the post of .......................................


and the facts stated above are true to the best of my knowledge and belief. In case of
any false statement, I am liable to any action the Government deem fit and proper.
A treasury challan of Rs..is attached herewith.

Date:
Place:

SIGNATURE OF THE APPLICANT

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