APPLICATIONFORM

1.

NameofthePostAppliedfor:.

2.
FullNameoftheCandidate:
(inCapitals)

................

Pasteyourrecent
passportsize
photograph

3.
DateofBirth:
DayMonthYear
4.
Gender:(Write1forMale,2forFemale)

5.

MaritalStatus:..

6.
Fathers/HusbandsName:

7.

MailingAddress(inblockletters):.

..

..PinCode:
.
Tel.No.:Mobile:
................
E.mailID(ifany):
................

8.
Nationality:..
9.

WhetherPhysicalHandicapped?:(Write1forYes,2forNo)

10.

Community(pleasetick()SCSTOBCGENERAL

11.

AllEducational/otherprofessionalQualifications/TrainingCoursesetc/DegreeExaminationonwards:

Level Exampassed/ Division/Grade Yearof

DegreeTrg. %ofMarks
Passing

12.

Durationofthe
Degree/Diploma

Board/University

Subject

Subjectof
Specialistion

Briefprofessionalexperience:

Office/Instt.Firm

Postheld Parttime/
Exactdatestobe
ContractBasis/ given(indicateday, TotalPeriod(inyears)
Adhoc/regular/ month&year)
Temp./pmt.
From
To
Years Months Days

Scaleof
pay

Natureof
duties

13.

Anyotherrelevantinformation:

14.

Detailsofenclosures: 1)....

2)....

3)....

I hereby declare that all the statements made in the application are true and complete to the best of my
knowledgeandbelief.IunderstandthatactioncanbetakenagainstmebytheCommission,ifIamdeclared
bythemtobeguiltyofanytypeofmisconductmentionedherein.IhaveinformedmyHeadOffice/Deptt,in
writingthatIamapplyingforthisselection.

Date:

Signature ofcandidate

Place:

Address: