Documente Academic
Documente Profesional
Documente Cultură
To
n
YY/MM/DD
i,-ir,l
iTotal experience
34.i i li (DETAILS OF ENCLOSURES): 1. 2.
3. 4. 5.
35. -iiiii (SELF DECLARATION):- - l-i iilin ni r l in li i - r |
I solemnly declare that the above statements and information are true.
i i r-nii lnli (Signature of the applicant with date)
ri i-i
li Affix
photograph
here.
Yes No
ii in rn (For
office use only)
in . Received Rs.___
i| . Dy.No._______
li Dated__________
Signature
Yes No
i INSTRUCTIONS
1.i| ll-i i -ir| n| ii - r| i i |All the entries should be filled up in black ink in English block letters only.
2. |ii i,ln n i i |ii i,iil -ii i |ii i,lnn |ii i,iil -ii i li,
SMU, FMU Exam Code /Prev. Yrs Exam. Code/ St. Certificate Code: Write exam code /ExamCode of last year / Statutory Certificate Code,
as SMU, FMU. i Code: FMR/FMU- i- i| i(|l-n,|l-n) First Class Managers (Restricted/Unrestricted), SMR/SMU- l,n| i|
i (|l-n,|l-n) Second Class Managers Certificate (Restricted/Unrestricted), SVR/SVU i (|l-n,|l-n) Surveyors
(Restricted/Unrestricted), FR/FU- i- (|l-n,|l-n), Foreman (Restricted/Unrestricted) MR/MU- -- (|l-n,|l-n) Mate
(Restricted/Unrestricted), MRS/MUS -- (|l-n,|l-n) -ii Mate (Restricted/Unrestricted) and Surveyors Certificate.
(For item No. 1 , 2 &16)
3. lnn i i i; .|. ., i . i lnn |ii i i; .|. ., i . i li Prev. Yrs ID No., Roll No. & Year: Write your Identity
No., Roll No. and Year of the exam appeared in previous year. (For item No. 2A)
4. | -,|l | - -ii i -il- lni i -n~ |ii -ii | i li | Sr SSC/SSC No: Write
number of your Senior Secondary/Secondary School Certificate or equivalent Certificate . (For item No. 6)
5.lnli -il- lni |ii -ii | lnli li | Date: Give date of SSC certificate. (For item No. 7)
6. i i i -n~ |ii -ii in i -ii i i- li | Board: Give the name of the Board/ Institution from where you have
obtained SSC Certificate. (For item No. 8)
7. -ii lnli i -ii | ini -- |ii | liiln lnli n ri| ilr | FAC DT. The validity of First Aid Certificate
(FAC) should extend to a date, which is not earlier than the date of exam. ( For item No. 11)
8. illi i ln|ii| DEG nii li-iii| DIP i |~ i F li | Qlf. Code: Give DEG for degree holders, DIP for
diploma certificate in mining and mine surveying or F for field candidates. (For item No. 12)
9. illi -ii . ilili ini ln|, li-i il -ii i | i li | Qualification certificate No : Write
certificate number of your academic qualification certificate such as degree, diploma etc . (For item No. 13)
10. -ii lnli in iili -ii | lnli li | Certificate Date: Give date of above qualification certificate. (For item No. 14)
11.-n|i lnli ln|,li-i -ii i |ii iilin ri | lnli li | Date of passing : Give date of declaration of result of
degree/diploma certificate. (For item No. 15)
12.iil -ii i iil -ii | i li | St. Certificate No: Give your statutory certificate No. (for item No. 17)
13.|ii i~ - | .|.-.. i- aa,, /r, -i i- i| l,n| i| i nii ra, i-
l i-,iin| i-- i i i | lnli nir li r i r| rii ilr | i-- i | i i
li ri i li n | The Bank draft/IPO for 100/- for First Class Managers, 75/- for Second Class Managers
and 50/- for Surveyors/Foremans Certificate of Competency Examination, payable to DGMS as fees should be obtained not more than one week
before filling up of your application form. If more than one IPO is enclosed, then the details may be given in a separate sheet . (For item No. 19)
14. |ii - --i|i r lii nii |ii i i -- ~i , l i i sss - l- i - -n|i r ri ni L93 li |
Clearly mention the year and subjects you have passed in earlier examination of the same types such as L 93if you have passed Legislation paper in the year
1993. (For item No. 22)
15 iil i , iil -ii in ri i i iil i | Stat. experience: Give statutory experience after obtaining relevant
statutory certificate (For item No. 24)
16 i l-llin n i ri | Centre Code: Use this centre code HYDrii Hyderabad, STR |nii-, Sitarampur
AJM- -, Ajmer 16a. i (i- |ii l) Centre code (for Foremans Exam only): Use this centre code- DHN- ii, HYD
- rii Hyderabad, NGP- in, Nagpur, STR |nii- ,Sitarampur, AJM- -, Ajmer, BHN - i, Bhubneshwar (For item no.28)
16.b iiii i l-lin i i ri (i- |ii l) Languate Code-use the following code (For Foreman exam only) EN- n|
English, HN- lr| Hindi, BN - ni| Bengali, OR- li Oriya, GU - nin| Gujarati, UR- Urdu, MR - -i-| Marathi, TM- nl- Tamil, TL-
nn Telugu, ML - -i- Malayalam, KN- Kannada. (For item No. 30)
17.i i i l-nn li li i - ii i ii iili, il-nn ii i i, ii, i i, i
il i -- ~i | Details of Experience & Service: Regarding details of experience, clearly mention the type of mines like opencast,
underground or other experience like Rescue, Research, Planning andteaching etc. (For item No. 33)
18.i - ll- -ii i ri i i|i ni i-i li-ilin i li | Affix copy of your recent attested photograph at the
space provided in the application form. .i ii ri - i| n i-i | i li-ilin lni i ii ni li -
i | i-i i- ii| i i- l ii rii ilr | Application form should be accompanied by four attested copies of your recent
photographs, with the name of the candidate written on the front side, enclosed in an envelope specified for the photographs.
20.i ii zz .-|. x za .-|. ii i -ni ln li i l-- ni ri (- zr,) i| | Two Self
addressed stamped ( 25/-each) envelopes should also be sent along with the application form (size 22 c.m. x 10 c.m.).
21.nn i ii | inini i -i i i| ii lil- srz iiii nrn iin| rin | Candidates furnishing
false information or forged documents shall be liable for punishment as provided under the provision of The Mines Act, 1952.
22.i| i iil-| ii ll- sc i| |ii l-i i llin |ii l liiln ii l-i i i i rini|
Candidates shall abide by the rules governing the conduct of written examination as provided in the examination bye -laws made under the provisions of
Metalliferous Mines Regulations, 1961.
23.i ii i| inini i ; nr -i| l i; inin i ln ri | Tie up all your documents with
application form surely to avoid any inadvertent detachment of your documents.
24.l, -i- nii i -ii i l| - lni i r, i si i| -ii i,inini | li-ilin lni
i ii | Attested photocopies of all certificates/do cuments except character, medical and experience certificates which are
accepted in original only, should be sent along with the application form.
25.i| lin -ii i, inini ii i l, i |ii i, ii ii -rilii , ii szcaa (nii) i-
|n i r| ;n - n i l i li s,a/,zas n r i | Application form along with all required
certificates/documents should be sent to the Director of Mines Safety(Exam) & Sec retary, Board of Mining Examinations, Directorate General of Mines
Safety, Dhanbad-826 001(Jharkhand) by registered post only so as to reach on or before 19/07/2013.