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Appln Form 02 2011

I hereby declare that all the above information furnished by me are true and complete. Furnishing of false / incomplete information will result in loss of employment at any stage.

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Mahadeva Prasad
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67 views

Appln Form 02 2011

I hereby declare that all the above information furnished by me are true and complete. Furnishing of false / incomplete information will result in loss of employment at any stage.

Uploaded by

Mahadeva Prasad
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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NEYVELI LIGNITE CORPORATION LIMITED

(A “NAVA RATNA” Govt. of India Enterprise)


P.O. NEYVELI-607 801, Cuddalore District, Tamil Nadu
Affix color
(Regd. Office: 135 Periyar EVR High Road, Kilpauk, Chennai-600 010)
passport size
APPLICATION FORM photograph
Advt. No. : 02/2011
Post : SENIOR RESIDENT JUNIOR RESIDENT

(Use Block Letters)

1. Name in full:

2. Father’s Name:

3. Mailing Address of the applicant


Description (a) Permanent (b) Present

House No,
Street Name,
Area / Locality,
City/Town/Village,
Taluk/ Mandal

District
State
Pincode
Nearest Railway Station
Contact Number

(c) email : ………………………………… @ ………………………………………

4. Date of Birth :

D D M M Y Y Y Y

5. (a) Community : SC ST OBC UR

(b) Sub-Caste (Attach documentary evidence :


in case of SC / ST / OBC)
6. If belonging to the following Special categories, details:
Category Yes / No Details

Ex-Serviceman

Physically handicapped If yes, nature of Handicap : OH / HH / VH

7. Recognised Educational / Professional Qualification(s)

Prescribed Month & Class


Name of the Course, Name of the Board / % of
Duration of Year of or
Degree or Exam. Institution / University Marks
the Course Passing Grade
8. Medical Registration Number : Registration No. -
Date of Registration –
Place of Registration –
9. Details of Experience (if any)

Central Govt. / Period of Employment


Name of the Employer
State Govt. / Designation & Scale of Reasons for
(Last employment first). Give From To
PSU / Quasi Nature of duties Pay Leaving
full address (DD/MM/YY) (DD/MM/YY)
Govt. / PVT.

11. Languages known:

Languages Speak Read Write


(a) Mother Tongue ………………………..
(b) Other Languages:
. i)
. ii)

12. Details of Training:


Institution in which training was obtained with
Nature of Training Remarks
duration and year of Training

I hereby declare that all the above information furnished by me are true and complete. I
am aware that furnishing of false / incomplete information will result in loss of employment at any
stage.
I also undertake to notify any changes in the information furnished within 7 days of such
change.

Place:

Date:
SIGNATURE OF THE APPLICANT

Note:
1. If the space provided in any column is insufficient, separate sheets may be attached.
2. Mention exact dates wherever required
3. Photostat copies of certificates in support of the information provided should be enclosed along with this
application form.

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