APPLICATION FOR THE POST OF ………………………………………………….

To:

SYNDICATE BANK RECRUITMENT PROJECT - 2009 PLEASE AFFIX

POST BOX NO. __________ YOUR RECENT
________________________ PASSPORT SIZE
PHOTOGRAPH AND
SIGN ACROSS
UDUPI DISTRICT, KARNATAKA STATE

In response to your advertisement in Employment News/Announcement in the Website dated

_______________________________ , I submit my Application in the prescribed format.
1. FULL NAME IN BLOCK LETTERS: (Leave one space blank between two parts of your name)
Mr./Ms. :

2. ADDRESS FOR CORRESPONDENCE:

* P O S T O F F I C E

* P I N C O D E

* D I S T R I C T

* S T A T E
* Mandatory fields and should invariably be filled up.

3. POST APPLIED FOR : ___________________________ CODE :

4. STATE APPLIED FOR
For Probationary Clerks : __________________________ CODE :
(Candidates can apply for one State only)

5. (i) CATEGORY TO WHICH YOU BELONG :

Write SC/ST/OBC/GEN in the box as applicable

(Please enclose photocopy of certificate in case of SC/ST/OBC) (OBC Certificate should be in

the prescribed format meant for Central Government posts and should have been issued on or
after 01.04.2008).

ii) IN CASE OF PERSONS WITH DISABILITY :

Write OH/VH/HI in the column as applicable
Please write percentage of disability (Please enclose photocopy of certificate) .

6. DATE OF BIRTH: DD MM YYYY

AGE (As on 01.01.2009): ___________ Years

Relaxation in Age (if claimed) : No. of Years Under category : __________

[Please refer to advertisement as regards your eligibility for claiming relaxation in Age]
 PARTICULARS OF FEE PAID: Application Fee may be paid at any of the Branches of
Syndicate Bank free of charges, by means of a Payment Voucher as per the format given in
Annexure – I.
If paid by cash at Syndicate Bank Branch:
Name of the Branch BIC Date of payment Transaction ID Amount (Rs.)

Copy of the Payment voucher should be enclosed to the application.

OR
Where there is no Syndicate Bank branch, candidates can remit the requisite fee by
Demand Draft favouring “Syndicate Bank Recruitment Project – 2009” payable at UDUPI
only.
If remitted by Demand Draft:

Name and Address of Date of Amount

Drawn in favour of D.D. No.
Issuing Bank/Branch Issue (Rs.)
SyndicateBank
Recruitment Project - 2009

Cheques, Money Orders, Pay Orders, Banker’s Cheques, Postal Orders, Postal Stamps
will NOT BE ACCEPTED. Demand Draft should be enclosed along with the application form.
Demand Drafts drawn outside Udupi are not accepted.
8. ADDITIONAL POST APPLIED FOR : ___________________________ CODE

___________________________ CODE

[Please note that separate application form should be submitted along with requisite
application fee for each additional post applied for)
9. YOUR CONTACT NO.:

STD Code No. Telephone No. Mobile No.

E- Mail Address

10. INDICATE BY  MARK IN APPROPRIATE BOX:

(i) GENDER : MALE FEMALE

(ii) Whether employed: YES/NO

If employed:
Name of the Employer

Full Address of the Employer

(iii): MARITAL STATUS:

SINGLE MARRIED WIDOW/WIDOWER DIVORCEE

(iv) a] Are you an Ex-Serviceman ? : YES NO

b] In case of Ex-serviceman, specify

1. No. of years of service :
 2. Date of Discharge : ______________
3. Rank at present/last held A) Acting ______________ w.e.f. ________
B) Substantive ______________ w.e.f. ________

(v) Are you a candidate who was domiciled in Kashmir YES NO

Division of State of Jammu & Kashmir during the
period 01.01.1980 to 31.12.1989.

(vi) Whether you belong to Religious Minority Community ? YES NO

If Yes, indicate by  in the appropriate box :

Christian Muslim Budhist Sikh Zorastrian
In case of SC/ST/OBC Candidate
(i) Name of the Caste/Tribe/Community : __________
(ii) Name of the state to which you belong ____________

11. FATHER’S NAME:

12. HUSBAND’S NAME (in the case of married women):

13. Whether Spouse is employed (in the case of those married) ? YES NO
If yes, Name of the Employer :
Post held :
Nature of duties :
14. NATIONALITY ___________________ RELIGION ____________________

15. PLACE OF BIRTH : Place _________________ Dist. ______________State __________

16. PERMANENT ADDRESS:

* P O S T O F F I C E

* P I N C O D E
* D I S T R I C T
* S T A T E
*Mandatory fields
17. HOME TOWN/VILLAGE : _________________ DISTRICT: _________________ STATE: ___________

18. Are you suffering from any major Health problems? YES NO
If yes, give details

19. EDUCATIONAL / PROFESSIONAL QUALIFICATIONS:

(from 10th Standard onwards as on 01.01.2009)
 A) Details of all Examinations passed on or before 01.01.2009. If all the information in the
box is not provided the application will be rejected.
Note: Percentage of marks secured in aggregate shall be rounded off to nearest 2 decimals.

Core Subjects other Date/Month/

Name of Name of Board/ Class/ % of
Particulars than Year of
the Degree University Division Marks
languages studied passing
X Standard

XII Standard

Graduation

Post Graduation

20. Level of Computer Literacy (Indicate by  mark in appropriate column)

MCA As a subject in Degree level

BCA As a subject in PG level
Certificate Course in Windows, MS
BE/BTech in CS,IT,IS etc.
word from a recognized Institute
PGDCA, DCA Any other (indicate details)
Pursuing Computer Course No Computer knowledge

21. PARTICULARS OF POST-QUALIFICATION EXPERIENCE (As on 01.01.2009) [Enclose Certificate

of experience]

Name of Employer & Length of Nature of Remarks

Period of service
Nature of activities Designation Service duties (Reason for
carried out by them From To Years months performed leaving service)

(If space is not sufficient please attach separate sheet)

22. Languages known : (Indicate by  mark in appropriate box) (Mention the names of
languages known in the appropriate column)

Sl. No. Language Read Write Speak

1
2
3
4

BEFORE MAILING APPLICATION, PLEASE CHECK THAT YOU HAVE CORRECTLY:

1. Mentioned the Name of the Post and Post code you have applied for.
2. Enclosed certified copies of the following:
a) Caste/Tribe/Community/Disability/Defence Service Certificate in the case of candidates belonging to
SC/ST/ OBC/PH/XS.
b) SSLC/X Class Certificate/Marks Card containing Date of Birth and languages studied.

c) Degree Certificate & Marks Card in the case of Probationary Clerks (Code 03).
 d) Degree and/or Post Graduate Degree Marks Card in the case of Officers (Code 01 & 02)
e) Computer qualification Certificate.
f) Certificate of experience in the case of Officers under Post Code 01.

3. Mentioned the details of Demand Draft/Payment Voucher enclosed. Ensure that name,
Date of Birth and Name of the post are written on the reverse side of the Bank Draft.
4. Furnished the Address for correspondence.
5. Enclosed the relevant certificate(s) for claiming relaxation in age.
6. Ensure that no column in the application is left blank. If any column is not relevant, mention
NA
7. Separate application with requisite fee for each post is sent.

DECLARATION (Candidates who are applying for Officers position)

I hereby declare that all the statements made 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 requirements of the relative advertisement, my candidature / appointment is
liable to be cancelled/terminated. I am willing to serve anywhere in India. I agree that Bank
has right to transfer me to any part of the country at its discretion.

I hereby agree that any legal proceedings in respect of any matter(s) or claims or disputes
arising out of this application and/or out of said advertisement can be instituted by me at
Courts/Tribunals/Forums at Udupi only shall have sole and exclusive jurisdiction to try any
cause/dispute. I undertake to abide by all the terms and conditions mentioned in the
advertisement given by the Bank.

Place :_____________ Date :__________

__________________
Signature of applicant

DECLARATION (Candidates who are applying for the post of Probationary Clerk)

I hereby declare that all the statements made 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 requirements of the relative advertisement, my candidature / appointment is
liable to be cancelled/terminated. I am willing to serve anywhere in the State opted by me. I
agree that Bank has right to transfer me to any part of the State opted by me, at its discretion.

I hereby agree that any legal proceedings in respect of any matter(s) or claims or disputes
arising out of this application and/or out of said advertisement can be instituted by me at
Courts/Tribunals/Forums at Udupi only shall have sole and exclusive jurisdiction to try any
cause/dispute. I undertake to abide by all the terms and conditions mentioned in the
advertisement given by the Bank.

Place :_____________ Date :__________

___________________
Signature of applicant