FORMAT OF APPLICATION

APPLICATION FOR THE POST OF LDC Affix recent

passport size
1. Name in Full (in block letters): ___________________________________ photo duly
attested by
2. Sex (Tick
Appropriate Box) : Male Female
Gazetted Officer
3. Date of Birth : _____/______/________
DAY/MONTH/YEAR
4. Name of Father/Husband : Candidate signature
5. Address for communication (in block letters with Pin code )
___________________________________________________________________________________________
___________________________________________________________________________________________
______________________________________________________________
City : _____________________________________________ Pin code
6. Whether belongs to :
Gen SC ST OBC Physically Handicapped Ex-Servicemen
(Tick
appropriate box)

7. Educational qualification (attach attested copy of the certificate)

Sr.No Exam Name of Board Year of Roll Percentage of Class
passed passing Number marks
secured

8. Details of payment of fees :

Bank Name: ______________________________________ Branch name __________________________
Amount of Demand Draft Rs. _____________ Demand draft No. ______________ D.D. Date : ___________
I do hereby declare that the statements made in the application are true, complete and correct to the best
of my knowledge and belief. I understand and agree that in the event of any information being found false or
incorrect or incomplete of ineligibility being detected at any time before or after selection/interview, my
candidature is liable to be rejected. I shall be bound by the decision of the competent authority.
Place : ____________________

Date : ____________________ Candidate’s Signature

Check list for enclosures (please put
tick mark in the box)

1) Age proof (XII certificate) 2) Caste certificate

(if belong to SC/ST/OBC)

3) Certificate of proof, if belong to 4) Educational Qualification

PH/Ex-SM/Sportsman

5) Demand Draft 6) Photograph

7) Self-addressed stamped (Rs. 10) envelope

 EMPLOYEES STATE INSURANCE CORPORATION
(MINSITRY OF LABOUR, GOVERNMENT OF INDIA)
Regional Office, EDC Plot No. 23, Patto Panaji – Goa 403 001

RECRUITMENT OF LDC
Applications in the format given in this advertisement are invited for filling up the following
vacancies in Goa Region of the ESI Corporation. The break-up of the vacancies is as follows:-

Genl. OBC Total

01 01 02

Vacancies are subject to change.

A. Examination Centre: Panaji.

B. Pay & Allowance: The post will carry the pay scale of Rs. 5200 – 20200 + 1900 Grade Pay, plus
allowance, as admissible to the employees of ESIC. Starting pay will be 5830 + 1900 Grade pay.

C. Age limit: Between 18-27 years as on 30/04/2010.

Age relaxation:
a) 5 years in case of SC/ST candidates.
b) 3 years for other backward classes as notified by the Govt. of India.
c) In case of Ex-servicemen period of service rendered in the Armed forces plus 3 years.
d) In case of physically handicapped persons 10 years.
e) Relaxable in the case of E.S.I. Corporation employees and Govt. servants as per rules.

D. Qualification:
i) Higher secondary passed (passed 12th standard or equivalent from a recognized board or
educational institute.)
ii) Working Knowledge of Computer including use of office suites and data base.

E. Fee & Mode of payment: A demand draft for Rs. 75/- (Rupees Seventy Five only) drawn in favour
of State Bank of India or its associate banks. (State bank of
Hyderabad/Mysore/Travancore/Indore/Patiala/Bikaner & Jaipur/ Saurashtra) in favour of E.S.I.
Corporation and payable at Panaji.
Candidates belonging to SC/ST/PH/Ex-servicemen categories and employees of ESI
Corporation are exempted from payment of examination fee. Criteria for reservation of the
physically handicapped persons and sportsmen will be as per Govt. of India instruction.
NOTE:
i) Fee once paid will not be refunded under any circumstances.
ii) Demand draft drawn should be on State Bank of India or its associate bank obtained on or after
publication of the advertisement.
iii) Fees paid by any other mode will not be accepted.
iv) The candidate must write his/her name and address on back of the Demand draft.

F. Scheme of Examination :
a) The Lower Division Clerks examination will consist of two parts viz :-
Part I: - The written test will consist of one paper for 200 marks containing 4 parts: (i) English
language (ii) General Intelligence & General Aptitude (iii) Numerical aptitude and (iv) General
awareness. Each question shall carry one mark. The question in all the four parts will be of objective
type (multiple choice) ones. Except English language the other questions will be in English/Hindi.
The examination will be of 03 (three) hours duration.
Part II :- The Corporation reserves the right to admit only that much candidates as considered
necessary by it for the skill test in knowledge of computer, including use of office suites and data
bases, based on the performance of candidates in Part-I written test.

G. How to apply: Application strictly as per format printed in this advertisement shall be sent in an
envelope super scribing “Application for the post of L.D.C.” to the following address by Regd.
Post/Speed Post.
THE REGIONAL DIRECTOR
EMPLOYEES’STATE INSURANCE CORPORATION
REGIONAL OFFICE GOA
PANCHDEEPBHAVAN
EDC PLOT NO. 23,
PATTO PANAJI –
GOA – 403 001.
 The following documents should be attached with the application form:

i) Two copies of recent passport size photographs duly attested by a Group “A”/Group “B” Gazetted
Officer with one photograph pasted on the application form.
ii) Attested copies of certificate and testimonials in proof of age/date of birth/educational
qualification/caste/experience, etc.
iii) Attested copy of community/status certificate in the prescribed form in case of candidates
belonging to SC/ST/OBC/Ex-Servicemen categories. Candidates claiming reservation/age relaxation
on grounds of belonging to the OBC, should submit the community certificate in Annexure ‘A’
prescribed vide Govt. of India Department of personnel and Training OM No.36012/22/93-Estt
(SCT) dated 8.9.93 and modified vide G.O.I. DOPT’s OM No. 36033/3/2004-EST(Res) dated
9.3.2004, failing which the benefit of reservation or age relaxation will not be given.
iv) One self addressed and stamped (stamps worth Rs. 10/-) envelope of size 23 cms x 10 cms.
v) Demand Draft of Rs. 75/- drawn in favour of Regional Director ESI Corporation and payable at
Panaji.

Those candidates who are employed in Govt./Semi-Govt./Autonomous bodies etc. should

send their application through “proper channel”. However they may send an advance copy of their
application along with demand draft and other certificates and testimonials so as to reach this
office before the due date.

NOTE - I : The application and other documents should be arranged in the following order one
below the other and tightly tagged or stapled on the left hand side top corner.
1) Additional photograph.
2) Application form.
3) Attested copies of certificates
4) Self-addressed envelope.

NOTE – II : The Demand Draft should not be tagged or stapled but should be pinned or clipped at
the bottom of the application form.

H. The last date for receipt of application form is 30/04/2010 up to 5.15 p.m.

I. General Conditions :
1. A candidate should submit one application only. Submission of more than one application may
lead to rejection of all the applications submitted.
2. Mere submission of the application does not confer any right on the applicant to be called for
written test.
3. Application should be submitted strictly in the prescribed format only and all columns should be
filled up in block/capital letters in the candidates own handwriting.
4. Application should be sent in a cover superscribed as “Application for the post of LDC” by
Registered post/speed post, so as to reach the Regional Office, ESI Corporation, PANCHDEEP
BHAVAN, EDC PLOT NO. 23, PATTO PANAJI GOA – 403 001 BEOFR DUE DATE.
5. Incomplete/unsigned applications received without photographs certified copies of required
certificates such as educational qualification, caste/community etc. and those received after the
prescribed last date for receipt of application will summarily be rejected without any
communication to the candidate.
6. No TA/DA will be paid to any candidate including SC/ST candidates for appearing in the written
test.
7. Wrong declaration/submission of false information or any other action contrary to law shall lead
to cancellation of the candidature at any stage.
8. No interim correspondence will be entertained.

CAUTION: Canvassing in any form will be disqualification and shall lead to cancellation of the
candidature.

REGIONAL DIRECTOR
 {ks=h; dk;kZy; xksok
deZpkjh jkT; chek fuxe
iapnhi Hkou ] bZ-Mh-lh- IykWV ua- 23] ikVks] i.kth xksok 403001
fuEu Js.kh fyfid ds in ij HkrhZ

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i= vkeaf=r fd;s tkrs gSA fjDr inksa dk fooj.k fuEu izdkj gS %&

lkekU; vU; fiNMk oxZ dqy

01 01 02

fjfDr;ksa dh la[;k ifjofrZr gks ldrh gS

d- ijh{kk dsanz % i.kth

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ds deZpkfj;ksa dks ik=rk ds vuqlkj ns; vU; HkRrs “kkfey gSA vkjfEHkd osru #i;s 5830 $ xzM
s osru #- 1900@&
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vk;q lhsek esa NwV %

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(iv) “kkjhfjd #i ls fodykax ds fy, 10 o’kZ
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a
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(ii) fMekaM MzkQV Hkkjrh; LVsV cSd
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(iv) vH;FkhZ cSd
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p- ijh{kk ;kstuk %
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a As vaxzt
s h ds
vfrfjDr vU; iz”u vaxzt
s h@fgUnh esa gksx
a As ijh{kk dh vof/k 3 (rhu) ?kaVs dh gksxhA

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,oa MkVk&osl lfgr dEI;wVj Kku dh dkS”ky ijh{kk ds fy, dsoy mrus mEehnokjksa dks cqykus dk vf/kdkj
lqjf{kr gksxk ftrus dh vko”;drk gSA
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vkosnu i=” fy[kk gks vkSj bls fuEufyf[kr irs ij Hkstk tk, %

deZpkjh jkT; chek fuxe

{ks=h; dk;kZy; xksok
iapnhi Hkou] bZ-Mh-lh- IykWV ua- 23]
ikVks] i.kth] xksok&403001

vkosnu ds lkFk fuEu nLrkost layXu djsa &

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ls ,d vkosnu ij fpidkbZ xbZ gks]
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lk{;kafdr izfr;ka
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tkfr@in ds izek.k i= dh lk{;kafdr izfrA vU; fiNMk oxZ ds lnL; gksus ds vk/kkj ij vkj{k.k@vk;q lhek esa
NwV dk nkok djusokys mEehnokjksa dks Hkkjr ljdkj] dkfeZd ,oa izf”k{k.k foHkkx ds dk;kZy; Kkiu la[;k
36012@22@93&LFkk (,l-lh-Vh-) fnukad 08-09-93 }kjk fu/kkZfjr rFkk blh foHkkx ds dk;kZy; Kkiu la-
36033&2&2004& bZ ,l Vh ( vkj bZ ,l-) fnukad 9-3-2004 ds }kjk la”kksf/kr] vuqyXud ‘d’ esa izek.k i= izLrqr
djuk gksxk] tks u fd, tkus ij vkj{k.k ;k vk;q lhek esa NwV dk ykHk ugha fn;k tk,xkA
iv) (10@& #i;s ewY; dk ) fVdV yxk 23 ls-eh-x 10 ls-eh- vkdkj dk viuk irk fy[kk ,d fyQkQk
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2- vkosnu i=
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8- fdlh Hkh varfje i=kpkj ij /;ku ugha fn;k tk,xkA
psrkouh % fdlh Hkh izdkj ls dh xbZ iSjoh dks vik=rk ekuk tk,xk rFkk bl ls mEehnokjh j} dh
tk,xhA

{ks=h; funs”kd
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fpidk,a

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3- tUe fnukad %& @ @ -

fnu@ ekg @o’kZ

4- firk@ifr dk uke % &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&

5- i=kpkj ds fy, irk ( cMs+ v{kjksa esa fiu dksM lfgr )

&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&

&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&

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6- fdl loaxZ ds lnL; gS %

lkekU; v-tk- v-t-tk- vU; fiNM+k “kkjhfjd #i ls HkwriwoZ
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( mfpr CkkDl esa
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7- “kSf{kd ik=rk (izek.k i= dh lk{;kafdr izfr layXu djs)a %

dz- la mRrh.kZ ijh{kk cksMZ dk uke mRrh.kZ gksus vuqdzekad izkIr vadks Js.kh
dk o’kZ dk izfr”kr

8- “kqYd ds Hkqxrku dk C;kSjk %

cSd
a dk uke % &&&&&&&&&&&&&&&&&&&&&&&&&&&&& “kk[kk dk uke &&&&&&&&&&&&&&&&&

fMekaM MzkQV dh jkf”k #- &&&&& fMekaM MzkQV la[;k &&&&&&fM`ekaM MzkQV dh rkjh[k&&&&&&&&&&&

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LFkku %

fnukad% mEehnokj ds gLrk{kj

vuqyXudksa dh tkap lwph ( d`i;k CkkDl esa
fpUgkafdr djsa )

1)- vk;q izek.k ( ckjgoha d{kk dk izek.k i=) 2)- tkfr izek.k i=
( ;fn v-tk-@v-t-tk-@vU; fiNMk oxZ
ds lnL; gks )
3)- lk{; dk izek.k i= ( ;fn “kkjhfjd #i

ls fodykax@ HkwriwoZ lSfud@f[kykM+h gS)a 4) “kSf{kd vgZrk

5)- fMekaM MzkQV 6)- QksVks

7)- (#- 10@& dk) fVdV yxk viuk irk fy[kk gqvk fyQkQk