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Application for the Post of LDC

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103 views3 pages

Application for the Post of LDC

Uploaded by

kartikchouhan785
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Application for the Post of Lower Division Clerk (LDC)

1. Advertisement No. 1-11/2019-2020/ IWST/Estt./2906


2. Full Name of the candidate ( in Block Letters):__________________________
3. Father’s / Husband’s Name:________________________________________
4. Nationality:__________________ Paste recent
passport Size
5. Correspondence Address (In Block Letters)____________________________ Photograph

_______________________________________________________________
_______________________________________________________________
PIN Code___________ Mobile Ph. No: ________________Email ID___________________

6. Amount of Application Fee/Processing Fee: Bank Demand Draft No. & date: ………………………………………..
7. Category to which the candidate belongs: Please (√)

General/UR OBC SC

(If SC/OBC) please attach self-attested copy of the latest certificate issued by the competent authority)
8. Sex: Please (√)

Male Female

9. (a)Date of Birth: Date :________Month :__________Year :__________


(Attach copy of the Birth Certificate/10th Class/SSLC/Matriculation Certificate)

(b) Age as on 03-01-2025: _______Years _________ Months ________ Days

10. Educational qualification (please attach self-attested copy of certificates and Mark-sheets):

Examination passed Subjects Year of Name of the recognized Percentage


(10th Std. onwards) Passing Board/University of Marks
11. Additional information, if any:

12. Whether the candidate is under any contractual obligation to serve Central/State Govt./Any
public Sector undertaking or Autonomous Body and if so, give details (attaché No Objection
Certificate)

DECLARATION

I hereby declare that all the facts mentioned in this application are true, complete and correct to the
best of my knowledge and belief. I understand that in the event of any information being found false or
incorrect at any stage or not satisfying the eligibility criteria according to the requirement of the relative
advertisement, my candidature/appointment is liable to be cancelled/terminated.

(Signature of the Candidate)

Place:
Date:

Check list of documents to be submitted along with the application


(Please tick “√“at relevant box):
Sl.
No Item/Document Yes No
.
1. Duly signed and completed application form
Self attested copy of age proof (10th Std.
2. certificate, Birth Certificate, Transfer
Certificate)
3. Self Attested copy of certificates of
educational qualification
4. Self-attested copy of Caste certificate
belonging to SC/OBC
Passport Size photographs with their name &
5. post written in capital letters on the back
side of the photographs (3 nos.)
6. Demand Draft

(Signature of the Candidate)


Place:
Date:
Annexure – A
(in the case of Govt. employees)

Certificate to be furnished by the Employer / Forwarding Authority:

Certified that:

(i) The particulars furnished by Shri/Smt.________________________________ are correct.


(ii) There is no vigilance / disciplinary case either pending or contemplated against him / her.
(iii) Integrity of the applicant ……………………………………………………
(iv) Photocopies of the up-to-date ACRs, attested by an officer not below the Rank of an Under
Secretary to the Govt. of India are enclosed.
(v) In the event of his/her selection, there is no objection to relieve/spare him/her within the time
specified in the office appointment.

(Signature of the Head of the Department / Forwarding Authority)

Department / Office with seal /T el. Ph .No.:_____________________

Date:

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