Sunteți pe pagina 1din 1



1. Advt.No. : R&D/86

2. Post applied for: ______________________________________________________________________

3. Name of the candidate: ________________________________________________________________

4. Father’s/Husband’s Name: ______________________________________________________________

5. Date of Birth: (dd/mm/yyyy) _____________Day __________ Month __________ Year

6. Age as on 30.04.2010: ____________Days ________ Months __________ Years

7. Nationality: _________________ 8. State of Domicile (state belongs to): _________________________

9. Category (SC/ST/OBC): _______________________________________________________________

10. Gender (Write M or F): ___________

11. Complete Correspondence Address: _____________________________________________________

District: ___________________________ State: _____________________Pin ___________

12. Qualification (Secondary School onwards):

Name of Name of Duration Date of Date of # Percentage
Exam. Institute/University of Course Admission Passing of marks
Passed (DD/MM/YY) (DD/MM/YY) obtained

# in case of CGPA/OGPA or Grade, mention equivalent percentage of marks as per University/Institute

norms. Percentage of marks not to be rounded off.

13. Work Experience:

Name & Address of the Post Period Nature of Salary Reason for
Organization/employer held Job drawn leaving
From To

14. Bank Teller details: Teller No.________ Date of Issue ______ Issuing Bank _______
15. E- mail id: ___________________________
16. Phone No. : _________________________

I hereby declare that the above information is true to the best of my knowledge. I understand that my
candidature will be cancelled, if the information is found to be false or incorrect or my application is

Place & Date: ________________________ Signature: _________________