Annexure-1

RAILWAY RECRUITMENT BOARD________________________________ Roll No. (For official use only)

APPLICATION FORM FOR JOINT EMPLOYMENT NOTICE NO.01/2009 Control No.: (For official use)
PLEASE FILL UP THE APPLICATION IN CAPITAL LETTERS IN OWN HANDWRITING.

Signature should not be in Capital letters. Paste (do not pin or staple)
(All applications must be submitted in A4 size 80 GSM paper) (bond paper) here your recent colour passport
size photograph of size 4 cm x 5
1. CATEGORY No. & POST : cm (The colour photograph
(for single category) Cat No. Post should not be more than
3 months old)
Not to be attested
Indicate options below in order of preference where single application is prescribed for
more than one category (you will only be considered for the post(s) indicated below)

Option Cat. No. Post Option Cat. No. Post Signature of candidate in the above
box below the photograph
1 3
2 4

2. Choice of Railway (wherever applicable) 1St 2nd 3rd

3. NAME OF CANDIDATE

4. COMMUNITY (Tick ()

*OBC Certificate to be submitted in the form as prescribed in Annexure 4 to Employment UR OBC SC ST

Notice. OBC Certificate older than one year from the date of closure of Employment Notice and
without Non-creamy layer certification is not valid and will be rejected
5. FATHER'S NAME
6. DATE OF BIRTH (DD/MM/YYYY)
7. AGE (as on.............................)
(Refer para 2 of Employment Notice) Years Month Day
8. VISIBLE MARK OF IDENTIFICATION ON BODY
(To be filled compulsorily)

9. Qualification (Fill in only those qualifications prescribed for the posts applied for)
(A) Academic Qualification University Year of passing Subjects Marks %
SSC / X / Matric

Higher Secondary /
XII / Inter
Graduation

Post Graduation

Others

(B) Academic Qualification University / Board Year of passing Discipline / Marks %

Trade
I.T.I/Act Apprentice

Diploma

Engineering Degree

Others

10. ADDRESS
(FOR CORRESPONDENCE)

State........................................................................................... PIN CODE

11. NEAREST RAILWAY STATION

(For issue of free railway pass to
SC/ST candidates)

Left hand Thumb Impression

of candidate in this box —>

Signature of the Candidate

(Not in Capital Letters)
Note : 1) Candidate must fill up their name, father's name and date of birth as indicated in their Matriculation Certificate.
2) Candidate should put their full signature at all the places in the same language (in English or in Hindi).