APPLICATION FORMAT

APPLICATION FOR THE POST OF SECURITY OFFICER IN UNITED BANK OF INDIA

(Fill all columns in legible capital letters & use 21 cms x 34 cms size paper)

General Manager,
(Resources Management) PLEASE AFFIX
United Bank of India, YOUR RECENT
Head Office, PHOTOGRAPH
11, Hemanta Basu Sarani, AND SIGN
Kolkata – 700 001 (W.B.) ACROSS

I hereby submit my application for the above post in the prescribed format.

1. FULL NAME (IN BLOCK LETTERS) (Leave one space blank between two
parts of your names)
Mr./Mrs.

2. ADDRESS FOR CORRESPONDENCE

3. (i) Indicate Category to which you belong to by Ticking the appropriate box
SC ST OBC GENERAL
(Please attach attested copy of Certificate wherever necessary)

(ii) Persons with Disabilities please tick the appropriate box.

Percentage of disability………….. VH HI OH
(Please attach attested Photostat copy of Medical Certificate
issued by Medical Board at District Level)

Do you intend to use the service of a Scribe? YES NO

4. Date of Birth (As per School leaving Certificate SSLC)

Date_______ Month_____ Year________.

Age as on 01.01.2009 ____Years____ Months______

Contd….2
 //2//
5. Details of Application fee.

Name & Name & Date of issue DD/Bank Pay Amount

address of the address of the Order No.
issuing Bank drawee Bank

[Demand Drafts / Pay Orders may be drawn in favour of “United Bank of India –
Specialist Officer Recruitment Project – 2008”]

[Fees for the post is Rs.400/- for General and OB C candidates and Rs.50/- (towards
postal charges only) for SC/ST/VH/HI/OH candidates. Payment by Cash, Cheque,
Postal Stamps, Money Order etc. will not be accepted and such applications will be
rejected]

6. CONTACT NO.: TELEPHONE NO. (with STD code):_________

FAX_______________ E-MAIL______________ MOBILE NO.:______________

7. GENDER : Tick in the appropriate box

MALE FEMALE
8. Please specify your

(i) Date of Discharge:____________

Rank at present / last held A) Acting__________w.e.f.______________
B) Substantive______w.e.f.______________

(ii) Are you a candidate who had ordinarily been domiciled in Kashmir Division
of the State of J&K during the period of 01.01.1980 to 31.12.1989?

YES NO

(iii) Whether you belong to Minority community?

(Tick in the appropriate box) YES NO
If yes, please state the religion:
______________
(iv) In case of SC/ST/OBC Candidate: ____________
(a) Name of the Caste / Tribe / Class: _________

(b) Name of the State to which you belong: _____

9. FATHER’S / HUSBAND’S NAME: (IN BLOCK LETTERS)

10. NATIONALITY: ______________

11. PLACE OF BIRTH: Place____________Dist:_____________State_____________

Contd….3
 //3//

12. PERMANENT ADDRESS (IN BLOCK LETTERS):

13. Educational and Professional Qualifications:

(a) Details of Graduation / Post Graduation as per the eligibility criteria prescribed
for the posts concerned in the advertisement (As on the date of application)
If all the information in these boxes is not provided, the application will be rejected.
Particulars Name of the Degree Class / Division Percentage of
and Discipline aggregate marks
Graduation

Post Graduation

b) Details of Education (10th standard onwards)

Examination Name of the Subjects Date, Percentage Class /
passed Institution/University studied in Month, of aggregate Division
detail year of marks
passing

14. Particulars of Post Qualification Experience including the Present Occupation / Job
(As on the date of application):

Name of the
employer (s) / Designation Period of Service Length of Nature of Remarks
firm etc. and and rank, if Service duties (Reasons
the nature and any Yrs. performed for leaving
details of From To Months/ in detail services)
activities days
carried out by
the employer

Contd….4.
 // 4 //

15. Languages known:

Sl.No. Language Read* Write* Speak*

*(Mark ‘X’ in the appropriate box)

BEFORE MAILING APPLICATION PLEASE CHECK THAT YOU HAVE CORRECTLY

MENTIONED.

1. Category / Sub-category and have enclosed copies of necessary certificates

for SC / ST/ OBC / VH / HI / OH / XS candidates.

2. Details regarding fees (Demand Draft / Pay Order).

3. Address for correspondence.

4. Details for claiming relaxation in age and the relevant certificate is

enclosed.

DECLARATION: I hereby declare that all statements made in this application are true,
complete and correct to the best of my knowledge and belief. I understand in the event
of any information belong 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
any where in India. I agree that Bank has the 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 Kolkata and Courts / Tribunals / Forums
at Kolkata only shall have sole and exclusive jurisdiction to try the cause / dispute. I
undertake to abide by all the terms & conditions mentioned in the advertisement given
by the Bank.

PLACE:

DATE: SIGNATURE OF CANDIDATE