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(All Information Must Be Furnished in Capital Letters Only

The document provides an application form for a government job posting. All information must be provided in capital letters. The form requests personal details like name, date of birth, category, nationality, address, qualifications, experience, and a declaration that the applicant meets eligibility criteria and will accept assignments anywhere in India if selected. Applicants must also certify that all information provided is correct and incomplete.

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Harish Chandran
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20 views

(All Information Must Be Furnished in Capital Letters Only

The document provides an application form for a government job posting. All information must be provided in capital letters. The form requests personal details like name, date of birth, category, nationality, address, qualifications, experience, and a declaration that the applicant meets eligibility criteria and will accept assignments anywhere in India if selected. Applicants must also certify that all information provided is correct and incomplete.

Uploaded by

Harish Chandran
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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[ALL INFORMATION MUST BE FURNISHED IN CAPITAL LETTERS ONLY]

Advertisement No. : NIC/2010/01


1. APPLICATION FOR THE POST OF : ______________________________
2. Name in Full

(For Official Use)

: ___________________________________________

3. Mothers Name : ___________________________________________


4. Fathers Name : ___________________________________________
5. Date of Birth : ______________(dd/mm/yyyy)
6. Category :

SL.NO.

Affix recent
passport size
photograph duly
attested by
gazetted officer

SC / ST / OBC / GEN

SC - Scheduled Caste
ST - Scheduled Tribe
OBC - Other Backward Class
GEN - General
OBC candidates coming under CREAMY LAYER CLAUSE should indicate their category as
GEN.)
7. Whether working in Government :

Yes / No

8. Whether belongs to Visually Handicapped Category :

Yes / No

Percentage of disability : ________ % (in percentage)


9. Nationality ____________________________________________
10. Religion: ___________________
11. Gender

Male / Female

12. Marital Status: MARRIED / SINGLE / WIDOW / WIDOWER


13. Correspondence Address (in full) : ____________________________________________
________________________________________________________City _________________
District _________________________State _________________ PIN CODE ____________
14. Permanent Address (in full) : ____________________________________________
________________________________________________________City _________________
District _________________________State _________________ PIN CODE ____________

15. Email : ______________________________________________________________________


16. Qualifications
____________________________________________________________________________________________________
Examination Passed
Aggregate Marks Year of
Name of the Board/
(in % only)
Passing
University/Institution
____________________________________________________________________________________________________

____________________________________________________________________________________________________

17.

Speed of Typewriting: English _________ w.p.m. / Hindi ______________ w.p.m.

18.

Speed of Shorthand: English _________ w.p.m.

19.

Knowledge of Computer (in any): ________________________________________________


________________________________________________________________________________
________________________________________________________________________________

20. Details of experience (if any) :


____________________________________________________________________________________________________
Name of
Period of Service
Post Held
Scale of Pay/
Nature of
Employer
From
To
Gross Pay
Duty
____________________________________________________________________________________________________

____________________________________________________________________________________________________
Total experience in Months : ________________

DECLARATION
I hereby declare that I fulfil the eligibility criteria for the post in terms of
educational qualifications, age, etc. and I am aware that mere calling for written test,
skill test or interview shall not entail me as fulfilling the conditions of eligibility.
I shall if and when required, take up temporary/permanent duty in the discharge of
Governments assignments anywhere in India.
I certify that the foregoing information is correct and complete to the best of my
knowledge and nothing has been concealed/distorted. I understand that if at any time I
am found to have concealed/distorted any material information regarding my candidature,
my appointment is liable to be terminated without notice or compensation. I also declare
that I have never been convicted by any court of law.

Place: ______________
Date : ______________

(Signature of Applicant)

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