Scribd
Upload
8 views

Proforma

Uploaded by

Vivek Singh Parihar
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
8 views

Proforma

Uploaded by

Vivek Singh Parihar
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
You are on page 1/ 2

PROFORMA FOR APPLICATION FORM

1. Application for the post of :


Space for
photograph
2. Order of preference for the bench: duly signed
(New Delhi, Bhopal, Chennai, by candidate
Kolkata & Pune) on the front

3. Name & Address


(in Block letters):

4. Nationality:

5. Sex(M/F):

6. State of Domicile:

7. Date of Birth:

8. Father’s Name:

9. Date of Retirement under Central /State


Government rules:

10. Educational Qualifications:

Whether Educational and other qualifications required for the post are satisfied (if
any qualification has been treated as equivalent to the one prescribed for the post,
state the authority for the same):

Name of the University/Board Year of Division & % Subjects taken


Examination passing of Mark

(Attested copies of the relevant certificates/degrees to be attached)

11. Experience with specific reference to eligibility criteria:

12. Please state clearly whether in the light of entries made by you, do you fulfil the
requirement of the post:
13. Details of employment in chronological order starting with present post, listing in
reverse (you may enclose a separate self- authenticated sheet):-

Name & Designation Whether on Scale Period of service Nature of Reasons


Address regular/depu of pay work/ for
of tation/ experience leaving
employer Ad hoc From To

14. Total emoluments drawn per month both prior and after revision of scale of pay
in respect of present post.

15. Whether belongs to SC/ST/OBC/Ex.S/PH etc.


(Attested copy of the relevant Certificates to be attached)

16. Additional Information, if any:

17. Contact (Telephone No. (Off.) -------------- (Res.)--------------(Mobile)------------


Email ID:

I certify that the foregoing information is correct and complete to the best of my
knowledge and belief and nothing has been concealed /distorted. If at any time, I
am found to have concealed/distorted any material information, my appointment
shall be liable to be summarily terminated without notice.

(Signature of the candidate & full Address)

Date: ------------------
Place -------------------

Countersigned------------------------------------
(Employer with seal)

You might also like