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SSD Kalahandi Appl. Form

This is an application form for a district welfare officer position. It requests basic personal information such as name, address, gender, date of birth, educational qualifications and percentages. The applicant must declare that all information provided is true and correct, and understands that any false statements could result in cancellation of their candidature. The form requests documents such as ID proof, caste/category certificates, and attested copies of educational certificates be attached for verification.

Uploaded by

Lokanath Choudhury
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© © All Rights Reserved
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134 views1 page

SSD Kalahandi Appl. Form

This is an application form for a district welfare officer position. It requests basic personal information such as name, address, gender, date of birth, educational qualifications and percentages. The applicant must declare that all information provided is true and correct, and understands that any false statements could result in cancellation of their candidature. The form requests documents such as ID proof, caste/category certificates, and attested copies of educational certificates be attached for verification.

Uploaded by

Lokanath Choudhury
Copyright
© © All Rights Reserved
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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o APrLrcATroN FoRM.

To
The District Welfare Officer, Affix passport

Size

CATEGORY OF POST APPLIED FOR


(Notification No I Dt-.-_)

1. Full name of the candidate.


(in Block Capital Letters)

2. Father's / Husband's name.

Permanent Address.

4. Present Address.
(for correspondence)

q Whether SC / ST i SEBC / OBC I PH I


Ex - Serviceman.
(xerox copy of the cerlificates to
be attached in support of the claim)
o. Gender (Male / Female) :.

7. Date of Bir'th as recorded in :

the Matriculation certificate.

8. Age as on 30.11.2021 Years


[-l'n
9. Name of the Employment Exchange
andRegistration No.

10 Educational Qualification :

__(&ttg g!_g*e lf -attested xe ro x co p y 9f ce rt if ca t_qs


- i

I rrarne
Name of the ' Year
oitne I|
Vea, of
or Iioard/
Board/ Percentage
Ill ixamination Passing
iPassing] Unlversitv
UniversitV (wrthout secured. of marks
]
lll
=xaminatron I

1
rl 2_
I

:--l
extra
,o-plLqrl)
(without extra secured

I I- _ _q 4
t-- --" r
-i**-l-
i

ll
N.B.: Marks secured in Extra optional / Ancillary / Foundation subject should not be
included for calculation.

11. List of enclosures

DECLARATION
I do hereby declare that all the statements made in this application are true, complete and
correct to the best of my knowledge and belief. I have read the details in the advertisement notice
and do hereby declare that I fulfil all the conditions of eligibility prescribed" ln case of any of the
statement / particulars is /are found to be given wrong during or after the selectton, my candidature
for the said post will be cancelled / forferted by the authority.

Place Signature of the candidate.


l-\ ala

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