Application Format General

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Affix recent self-

attested passport
APPLICATION FORMAT
(Use Block Letters Only)
size photograph
here and attach
Advt. No. _________
one photograph
with application
Post applied for: __________________
District Opted_________________ (In case of Asst. System Manager or System Supervisor)

A. PERSONAL DETAILS:

1. Name (as appears in SSC certificate)

Please put a space between your first name, middle name (if any) and last name.
(E.g.: TV Meenakshisundaram OR Ajit Jyawant Phadke)
2. Father’s Name

3. Mother's Name

4. Name of the spouse (if married) ________________________________________

5. Date of Birth

DD MM YYYY

B.CORRESPONDENCE ADDRESS:
1. Address for correspondence:

2. City/Town: State Pin code

3. E-mail

4. Telephone Number
C. PERMANENT ADDRESS:

1. Address for correspondence:

2. City/Town: State Pin code

4. Telephone Number E-mail


E-mail
STD Code Telephone
D. ACADEMIC PERFORMANCE
1. Basic Qualifications: - Matriculation onwards:

Exam Institution/University/ Subjects Duration of Years of Aggregate Division


Passed Board studied study passing % of marks

2. Professional Qualifications (Please mention details of your relevant Discipline)


Degree Name of Branch of Month & Aggregate Full Time (FT)
institute/University Specialization Years of % of marks Part Time (PT)/
passing Correspondence(C)
(MM/YYYY)

(*If it is Cumulative Grade Point Average (CGPA), please convert it to % of Marks)


E. DETAILS OF EXPERIENCE (If required, please attach separate sheet)
Name of Designation Scale of Duration Whether Nature of Reason for
Organization regular or duties Leaving
From To not

(MM,YYYY) MM,YYYY
F. DETAILS OF DEMAND DRAFT:

Demand Draft No. Date Name of Bank Amount

G. Whether departmental candidate? Yes/No


Declaration:
I affirm that the information given in this application is true and correct to the best of my
knowledge and belief. I further undertake that if at any stage it is discovered that an attempt
has been made by me, willfully to conceal or misrepresent the facts, my
candidature/appointment shall be summarily rejected or terminated without any notice
Date:________________ Signature:

Place:________________ Name of candidate:____________

Instructions to the candidate:


1. Persons working under Central/State Govt. /Public Sector Undertakings should submit
their applications through proper channel. They may, however, send one advance copy
of the application along with requisite enclosures.
2. Incomplete applications are liable to be rejected.
3. Affix recent passport size photograph on the application.
4. Only Indian Nationals are eligible to apply.
5. Canvassing in any form will lead to disqualification.
6. No interim enquiries or correspondence shall be entertained.

Please Enclose:
1. Proof of Date of Birth.
2. Attested copies of Metric/Degree/Diploma/Experience Certificates (Do not attach
originals)

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