ANNEXURE-A

APPLICATION FOR THE POST OF CHIEF SECURITY OFFICER

TO:
SYNDICATE BANK
PD: HRDD
MANIPAL – 576 104 PLEASE AFFIX YOUR
UDUPI DISTRICT RECENT PASSPORT
KARNATAKA STATE SIZE
PHOTOGRAPH
AND SIGN ACROSS

With reference to your advertisement on Bank’s 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 : P I N :
S T A T E :

3. POST APPLIED FOR : Chief Security Officer

SC ST OBC GEN
4. (i) CATEGORY TO WHICH YOU BELONG :
Indicate by  mark in appropriate box
(Please enclose photocopy of certificate in case of SC/ST/OBC)

5. DATE OF BIRTH: DD MM YY

AGE (As on 01.08.2010): ___________ Years

6. DETAILS OF NON REFUNDABLE APPLICATION FEE (Demand Draft)

Name and Address of Amount

Drawn in favour of Date of Issue D.D. No.
Issuing Bank/Branch (Rs.)
SyndicateBank Recruitment
of CSO -2010

7. YOUR CONTACT NO.:

STD Code No. Telephone No. Mobile No.

E- Mail Address
8. INDICATE BY  MARK IN APPROPRIATE BOX:

(i) GENDER : MALE FEMALE

(ii): MARITAL STATUS:

SINGLE MARRIED WIDOW/WIDOWER DIVORCEE

(iii) Ex-serviceman/Commissioned Officer/Police Officer /Other equivalent, 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. ________

(iv) Whether you belong to Minority Community ? Yes No

(v) In case of SC/ST/OBC Candidate

(i) Name of the Caste/Tribe/Class : __________
(ii) Name of the state to which you belong ____________

9. FATHER’S / HUSBAND’S NAME:

10. NATIONALITY ___________________ RELIGION ___________

11. PLACE OF BIRTH : Place _________________ Dist. ____________ State ____________

12. PERMANENT ADDRESS:

D I S T R I C T
P O S T : P I N :
S T A T E :

13. HOME TOWN : _________________

14. EDUCATIONAL / PROFESSIONAL QUALIFICATIONS:

(from 10th standard onwards as on 01.08.2010)

Exami- Month &
Name of University/ % of Class/
nation Subjects Year of
Institution studied Marks Divn.
Passed passing
X

XII

Degree
 PG

15. COMPUTER KNOWLEDGE: INDICATE BY  : Yes / No

16. PARTICULARS OF POST-QUALIFICATION EXPERIENCE (As on 01.08.2010)

Name of Employer & Period of Length of Nature of Remarks

Designation
Nature of activities carried service Service duties (Reason for
/Rank
out performed leaving service)
From To Years months

(If space is not sufficient please attach separate sheet)

17. Languages known: (Indicate by  mark in appropriate box)

Sl. No. Language Read Write Speak
1
2
3
4

BEFORE MAILING APPLICATION, PLEASE CHECK THAT YOU HAVE CORRECTLY MENTIONED:

1. Enclosed certified copies of the following:

a) Defence/other Service Certificate
b) Caste/Tribe/Community in the case of candidates belonging to SC/ST/ OBC.
c) SSLC/X Class Certificate/Marks Card containing Date of Birth.
d) Degree Marks Card
e) Certificate of experience/Discharge.
2. details of Demand Draft and you have enclosed the same with the application form.
3. Address for correspondence.

DECLARATION
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 only at Udupi and
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