050719specimen Application
050719specimen Application
4. District : ………………………………………………………………..
7. Sex : ………………………………………………………………..
9. NIC No : ………………………………………………………………..
1 2
3 4
5 6
7 8
9 10
G.C.E (A/L) – YEAR: ………..
1 2
3 4
5 6
7 8
12. Degree
V. Duration : ………………………………………………………...………
…………………………………………………………………
…………………………………………………………………
…………………………………………………………………
17. Details of Two Non - related referees :
1: ……………………………………………………….………
………………………………………………………………..
………………………………………………………………..
2: …………………………………………………………..…..
…………………………………………..……………………
…………………………………………………………………
I hereby declare that the details given above are true and correct to the best of my
knowledge & belief.
………………………………………… ……………………..
Head of Department Date
Please Note: Applications which are forwarded without complying to the guidelines
specified in the vacancy advertisement will be rejected without opening the
envelope.