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FCI Application Form

ZONE-WISE RECRUITMENT FOR MANAGEMENT TRAINEE (GENERAL/ DEPOT/ MOVEMENT/ ACCOUNTS/ TECHNICAL/ CIVIL ENGINEERING/ MECHANICAL ENGINEERING/ ELECTRICAL ENGINEERING) Application Form for the Post of : MANAGEMENT TRAINEE (GENERAL), MANAGEMENT TRAINEE (DEPOT),

SOUTH ZONE
Registration No. : 271046
1.Candidate's Name 2.Father's Name 3.Gender 4.Date of Birth 5.Age(as on 01.08.2013) 6.Category : SAURAV KUMAR : MUKTESHWAR PANDEY : MALE : 07/09/1987 (supporting Document to be enclosed)

: 25 YEARS ,10 MONTHS ,25 DAYS : GENERAL NO NO NO NO 12.Nationality:INDIAN : : : SOUTH BANGALORE Preference 1 Preference 2 Preference 3 Preference 4 A B -

7.Whether Domiciled in the Kashmir Division in the State of J & K during the period 01-01: 1980 to 31-12-1989 (Enclose relevant certificate) 8.Whether Ex-Serviceman 9.Whether Person with Disabilities(PWD)/Physically Handicapped(PH) 10.Whether Departmental (FCI) Employee 11.Whether belonging to Minority Community : NO 13.Zone Applied For 14.Name of the Written Test Center 15.Preference of Post Code Applied for : 16.Educational Qualification: :
: :

Post Code

Post Code (s) Applied For

Name of Academic/ Professional Degree/Diploma(which makes you eligible)

Discipline

Name of the University / Borad

Year of Passing

Percentage of marks up to 2 decimal Duration of the points in Remrarks,if Course / aggregate any Programme of all years/semesters

A and/or B and/or C D or E or F or G or H
18.Email ID

AB

GRADUATE DEGREE OR EQUIVALENT B TECH

COCHIN UNI ELECTRONIC VERSITY OF S AND COM SCIENCE AN MUNICATIO D TECHNOL N OGY : : : : YES -

2013

48

64.41

17.Whether Completed

SAURAVATRIX@GMAIL.COM 7259762471 NO

19.Mobile Number 20.Experience: 21.Communication Address City State 22. Whether Fee Paid : YES 23.Mode of Payment Journal No. Name of Bank & Branch Branch Code : BANK CHALLAN : 010156624

: ROOM 303 2ND MAIN 4TH CROSS EXTENSION 724 NEAW SHIVA TEMPLE : BANGALORE : KARNATAKA District Pin Code : : BANGALORE 560054

Bank Reference No. Date of Deposit Amount

: 13011131092287 : 29/07/2013 : 550

: SBI DOLLAR COLONY : 9042

24.Declaration : 1. I have not submitted any other application for this examination. I am aware that if I contravene this rule, my application will be rejected summarily by FCI. 2. I have read the provisions in the Advertisement carefully and hereby undertake to abide by them. 3. I further declare that I fulfill all the conditions of eligibility regarding age limits, educational qualifications, experience etc. prescribed

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7/29/13

FCI Application Form

3. I further declare that I fulfill all the conditions of eligibility regarding age limits, educational qualifications, experience etc. prescribed for the post applied for. 4. I also declare that I do not stand debarred by FCI as on date and have never been convicted by any court of law. I also declare that no charge sheet is pending against me in any court of law.Further declare that I have never been dismissed or compulsorily retired from the service of the Corporation or from a Department of a State or the Central Government or from any Public Sector Undertaking. 5. For Candidate belonging to OBC. I declare that I belong to the community, which is recognized as backward class by the Govt. of India for the purpose of reservation in services as per order contained in Deptt. of Personnel and Training Office Memorandum No. 36012/22/93-Estt.(SCT)dated 8.9.1993. I also declare that I do not belong to the person/sections (creamy layer) mentioned in column 3 of the schedule of the OM mentioned above and modified vide Govt. of India DOPT OMs mentioned in the Notice. I further declare that I am in possession of OBC Certificate in the prescribed format given in the Notice of the Advertisement. 6. I hereby declare that all the statements made by me in the application are true, complete and correct to the best of my knowledge and belief and nothing has been concealed or suppressed. In the event of any information being found false or incorrect at any point of time my candidature / appointment may be cancelled / terminated without any notice and/or I shall be liable for any other action under the extant rules.

Date: Place:

Signature: Candidate's Name (in Capital letters): 25.CERTIFICATE FROM THE PRESENT EMPLOYER (For candidates serving in Central/State Government ,Public Sector Undertakings,and Autonomous Bodies)

Certified that the above mentioned information furnished by the Appplicant is true and there is no Vigilance/Disciplinary case pending against him/her. We have no objection to his/her applying for the above post in FCI and if selected, he/she shall be relieved as per this Organisation's norms subject to his/her compliance of all terms and conditions of the Service Rules. (Signature & Seal of Employer) 26 .Checklist: Self-certified copies of relevant certificates/documents to be enclosed with Application Form. I hereby cerify that the self-cerified copies of following certificates/documents are enclosed along with the duly completed online Application Form.In Case ,self-certified copies of the relevant certificates/documents are not enclosed with the online Application form ,my candidature/appointment may be cancelled/terminated without any notice. Bank Challan(3rd Copy-FCI Copy)/Demand Draft(on the back side of DD Name,DOB,Zone & Post applied for is indicated.) Date of Birth Certificate(as recorded in the Matriculation/Secondary Examination Certificate). Degree/Provisional Certificate of Degree/Diploma of Essential Qualification. Marksheet of Degree/Diploma. Caste(OBC/SC/ST)Certificate,if applicable. PWD/PH Certificate,if applicable. Experience Certificate,if applicable. No objection Certificate,if applicable. Ex-Serviceman Certificate, if applicable. Date: Place: Signature: Candidate's Name (in Capital letters):

(Please Print the form for Further Reference)

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