ANNEXURE IV DAMODAR VALLEY CORPORATION APPLICATION FORMAT

1. Name of the Post 2. Ref. DVC letters No 3. Name of the applicant in Full (In Block Letters & as appearing In Class X Pass Certificate 4. Fathers Name/Husbands Name 5. Name of College/Institute 6. Date of Birth (As per School Final) 7. Gender (Pl. put a tick mark) : : :
Affix your selfattested recent pass port size (size 3.5x3.5cm) photograph (not older than three months)

: : : :

8. Category 9. Whether Physically Handicapped

: :

UR

OBC

SC

ST

If yes, pl. specify the Type of PH OA BL OL HH

(Pl. tick \/ in appropriate box and submit certificate. PH should additionally tick category also. Attach Xerox copies of certificate in prescribed format duly attested in case of SC, ST, OBC, PH).) For format of SC/ST, OBC (Non- Creamy) & PH please refer to the DVC website. 10. Address for Communication : P.O. .City/Town.District State.Pin Code..Nearest Railway Station.......................................................................... E-mail address ............................ Contact.No.(Mobile) (Land Line No. with STD No.) 11. Permanent Address:

................................................................. P.O. .City/Town.District.......... .State.Pin Code........................................... Nearest Railway Station................................................... E-mail address ................................... Contact.No.(Mobile)........................................................

(Land Line No. with STD No.).......................................................

12. Martial Status (Pl.put a tick mark In the appropriate box.) 13. Nationality 14. Religion(If minority pl. specify)

: : :

Married

Unmarried

................................................. ----------------------------------------

15. Educational Qualifications a) Starting from School Final / Matric onwards : SL No. Name of the Exam Name of Board / University Whether Full Time Regular Course (Pl. state YES or NO Discipline/Major Subjects taken/specialization Year of Passing % marks in aggregate (not to be rounded off)

2 3

Matric / School Final (Class X) 10+2 (HS / Intermediate ) BE / B.Tech b) Professional Qualifications BE/B.Tech/B.Sc.(each semester), Branch .........................

Sl No

Exams Passed

Total marks obtained (marks obtained/full marks)

Date of Passing

% marks in aggregate (not to be rounded off)*

Remarks

1 2 3 4 5 6 7 8

1st Semester 2nd Semester 3rd Semester 4th Semester 5th Semester 6th Semester 7th Semester 8th Semester * In case of GRADE POINT system, % should be calculated as per conversion formulae of the University and if no formulae is given it should be converted on 10 point scale.

16. Visible marks of identification (Mole marks/Wound/Scar/Burn etc, if any)(Filling of this information is mandatory.) 17. Extra-Curricular Activities: (Only Inter School/College/University/District/State Level)

18. Details of any criminal/Civil/Vigilance case/Disciplinary Case ------------------------------------------------In which the candidate is involved. (Mandatory information)

19. Particulars of enclosures in support of claim :

DECLARATION I, do hereby declare that all the statements made in this application are true, complete, correct and in the event of any information being found false, incomplete, incorrect or concealing the fact, my candidature may be cancelled at any stage without any notice and without assigning any reason thereof even after selection. Place : -----------------Date : -----------------Please put your clear Left Thumb Impression (LTI) in the box on right hand side (Signature of the Candidate)

Verified and countersigned by Authorised Signatory of the College (With Date & Seal) N.B: Latest OBC Certificate issued within 6 months as per GOI Format & Caste Certificate of SC/SC and certificate of PH respective category to be submitted at the time of Interview.