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RAILWAY RECRUITMENT CELL, EAST COAST RAILWAY, BHUBANESWAR

APPLICATION FORM ( in A4 size paper )


E.N. No.ECoR/RRC/D/2013 dated 12.10.2013
Read the Employment Notification carefully before filling up the application form:

1. Name of the candidate (in capital letters):


2. Fathers/ Husbands name (in capital letters):



3. Nearest Railway Station:

4. Full address for correspondence:


5. Sex:

6. Nationality:

7. Religion:

8. Marital Status:

9. Date of Birth: Date Month Year

10. Tick ( )
Community :
UR OBC SC ST


11. Educational Qualification tick ( ) the appropriate column:

SSC/Matric HSC/SSC ITI Diploma Non Technical Technical
Graduate Post Graduate Graduate Post Graduate




12 Tick ( ) appropriate column, if applicable. (Enclose copy of certificate in support of claim)

Persons with Disabilities
VH HH OH
Widow / Divorced /
Judicially separated
Economically
Weaker Section
Serving
Railway
Employees
Central /
State Govt.
Employees
Staff of Quasi
Administrative
offices of Railways
Residents of
Jammu &
Kashmir


13. Write two visible Marks of
Identification (Moles etc.):

1.

2.





15. Put two specimen signatures below (Do not sign in capital letters): 16. Put two Left Thumb Impressions below(Must be clear and not smudged):
1. Specimen Signature 2. Specimen Signature 1. Left Thumb Impression 2. Left Thumb Impression








17. DECLARATION BY THE CANDIDATE (Please reproduce the following paragraph in your own running handwriting in the space given below):
I hereby declare that all the particulars given above by me are true and correct to the best of my knowledge and belief. In the event of any information
being found false, my candidature / appointment is liable to be cancelled / terminated.
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________


18. Place : _____________________________________________
19. Date: 20. Signature of the candidate (Do not sign in capital letters)










State PIN

Contact Phone No. with STD Code:
For office use only






Paste your latest
passport size
photograph

14. Details of IPO No. Date: Amount: Name of the Post office

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