APPLICATION FORM (OFFLINE)

ZONE-WISE RECRUITMENT FOR MANAGER & MANAGEMENT TRAINEE

(GENERAL/ DEPOT/ MOVEMENT/ ACCOUNTS/ TECHNICAL/ CIVIL ENGINEERING/ MECHANICAL ENGINEERING/ ELECTRICAL ENGINEERING)

(* Fields are mandatory) (To be filled in Capital Letters and signed in all pages by the Candidate only)

Application No. (For office use only): 1557865

1. Candidate’s Name * : Affix recent

(Name as recorded in the Matriculation/Secondary Examination Certificate.) Passport size
coloured
2. Father’s Name * : photograph

3. Gender * : (Male / Female)

(DD/MM/YYYY) (As recorded in the Matriculation/Secondary Examination Certificate, supporting

4. Date of Birth * : / / document should be enclosed)

5. Age as on 01/08/2013* : Years Months Days

6. Category * : (General / OBC / SC / ST)

7. Whether domiciled in the Kashmir Division in the state of J&K during (Yes/No) 8.Whether Ex-Serviceman : (Yes/No)
the period 01.01.1980 to 31.12.1989 ?(Enclose relevant certificate)

If yes, Nature of Disability Degree of Disability (in %) Scribe Required (Yes / No)
9. Whether Person with : (Yes / No)
Disabilities (PWD)/ (Refer to the Legend given in the Advt.) (40% and above) * if (B,LV,BLA,BA)
Physically
Handicapped (PH) *

10. Whether Departmental : IF YES

(FCI) Employee*
Yes/No CPF No Present Designation Date of Joining in FCI Present Place of Posting

11. Whether belonging to Minority Community* : (Yes / No) If yes, Specify Community:
.

(Muslim, Christian, Sikh, Buddhist, Zoroastrian (Parsee))

12. Nationality *:

13. Zone Applied For * : (North / South / East / West / North-East) (Candidate can apply for ONE ZONE ONLY)

14. Name of the Written Test Centre * : (Within the Zone applied for)

15. Preference of Post Code Applied For: (Refer Advertisement for Post Codes in the Zone for which you are applying and choose preference
carefully. Wrong submission will disqualify your candidature.) *
Preference - 1 Preference - 2 Preference - 3 Preference - 4

16. Educational Qualification: (Fill details of Qualification pertaining to you, which makes you eligible for the applied post(s))
Post Code Post Name of Discipline Name of the Year of Duration of the Percentage of Remarks, if any
Code(s) Academic/ University / Passing Course / marks up to 2
Applied Professional Board Programme decimal points in
For Degree/ Diploma aggregate of all
(which makes years/ semesters
you eligible)

A and/or B .
and/or C

D or E or F .
or G or H

In case of CGPA / OGPA / Letter Grades, please give equivalent percentage (%).
17. Whether Completed* : (Yes/ No) *Result awaited candidates need not to apply.
 18.Email ID : 19. Mobile Number : +91

20.Experience* : If yes, Total Experience:

(Yes / No) (In Months)

21. Communication Address* :

City* : District * :

State* : Pin Code* :

22. Whether Fee Paid (Write 1 or 2)*: Write 1 - if fee paid, 2 – if fee exemption claimed
23. Mode of Payment* Bank Challan Reference (if Mode of Payment is SBI Bank Challan)
(DD/Bank Challan): No. (14 Digits)* :
DD No. / Journal No.*: Issue /Deposit Date*:

Amount Name of Bank & Branch*: Branch

Rs.(500/1000)*: Code*:

24. Declaration:
1. I have not submitted any other application for this examination. I am aware that if I contravene this rule, my application will be rejected
summarily by FCI.
2. I have read the provisions in the Advertisement carefully and hereby undertake to abide by them.
3. I further declare that I fulfill all the conditions of eligibility regarding age limits, educational qualifications, experience etc. prescribed for the
post applied for.
4. I also declare that I do not stand debarred by FCI as on date and have never been convicted by any court of law. I also declare that no
charge sheet is pending against me in any court of law. Further declare that I have never been dismissed or compulsorily retired from the
service of the Corporation or from a Department of a State or the Central Government or from any Public Sector Undertaking.
5. For Candidate belonging to OBC :
I declare that I belong to the community, which is recognized as backward class by the Govt. of India for the purpose of reservation in
services as per order contained in Deptt. of Personnel and Training Office Memorandum No. 36012/22/93-Estt.(SCT) dated 8.9.1993. I
also declare that I do not belong to the person/sections (creamy layer) mentioned in column 3 of the schedule of the OM mentioned
above and modified vide Govt. of India DOPT OMs mentioned in the Notice. I further declare that I am in possession of OBC Certificate
in the prescribed format given in the Advertisement.
6. I hereby declare that all the statements made by me in the application are true, complete and correct to the best of my knowledge and belief
and nothing has been concealed or suppressed. In the event of any information being found false or incorrect at any point of time, my
candidature / appointment may be cancelled / terminated without any notice and/or I shall be liable for any other action under the extant
rules.
Date: Signature:
Place: Candidate’s Name (in Capital letters):

25.CERTIFICATE FROM THE PRESENT EMPLOYER

(For candidates serving in Central/State Government, Public Sector Undertakings and Autonomous Bodies)
Certified that the above-mentioned information furnished by the Applicant is true and there is no Vigilance/Disciplinary case pending against him/her. We
have no objection to his/her applying for the above post in FCI and if selected, he/she shall be relieved as per this Organization’s norms subject to his/her
compliance of all terms and conditions of the Service Rules.

(Signature & Seal of Employer)

26. Checklist: Self-attested copies of relevant certificates/documents to be enclosed with the Application Form.
I hereby certify that the self-attested copies of the following certificates/documents are enclosed along with the duly completed
application form. In case, self-attested copies of the relevant certificates/documents are not enclosed alongwith application form, my
candidature/appointment may be cancelled/terminated without any notice.
 Bank Challan (3rd Copy-FCI Copy)/Demand Draft (On the back side of DD Name, DOB, Zone & Post applied for is indicated).
 Date of Birth Certificate (As recorded in the Matriculation/Secondary Examination Certificate).
 Degree/Provisional Certificate of Degree/Diploma of Essential Qualification.
 Mark sheet of Degree/Diploma.
 Caste (OBC/SC/ST) Certificate, if applicable.
 PWD/PH Certificate, if applicable.
 Experience Certificate, if applicable.
 No objection Certificate, if applicable.
 Ex-Serviceman Certificate, if applicable.


Date: Signature:
Place: Candidate’s Name (In Capital letters):