Bihar Kshetriya Gramin bank

Recruitment Project-2009-10
Application for the post of Clerk-cum-Cashier
(Fill all columns in legible capital letters in his/ her own hand writing and use 8.27” x 11.69” size paper- A4 size).
Information in first five columns viz. Post, name, father’s Name, Address for communication and Permanent address must be
filled in ENGLISH ONLY
Paste your recent
To, size photograph and
Bihar Kshetriya Gramin Bank sign it across.
Clerical Recruitment Project-2009-10, Please retain with
Post Box No.7641 you three copies of
Malad (West) the same photo for
MUMBAI-400 064 subsequent use
(Delete whichever is not applicable)
Dear Sir,
With reference t Bihar Kshetriya Gramin Bank advertisement, I submit my application in the prescribed format:-
1. FULL NAME IN BLOCK LETTERS:
(Leave one space blank between two parts of your name)

2. FATHERS/ HUSBANDS NAME IN BLOCK LETTERS:

(Leave one space blank between two parts of name)

3. ADDRESS FOR COMMUNICATION (In Block Letters)

PIN

4. PERMANENT ADDRESS (In Block Letters)

PIN

5. Telephone No with STD Code:

Cell No:

E-mail address:

6. Gender (Please indicate by putting √ in the appropriate BOX)

Male Female

7. Category to which you belong (Please indicate by putting √ in the appropriate BOX)
SC ST OBC GENERAL

(Please attach attested Photostat copy of Caste Certificate of SC/ ST/ OBC as applicable, in the format prescribed by Govt
of India)
a. Religion:……………………………Sub-caste:…………………………………
b. Name of the State/ UT to which you belong:…………………….
c. If Person with Disability
(Please indicate by putting √ in the appropriate BOX)
Orthopaedically Hearing Impaired(HI) Visually Handicapped(VH)
Handicaped(OH)
 Percentage of Disability:……………………………………….
(Please attach attested Photostat copy of medical certificate issued by Competent Authority)
d. Are you eligible and intend to use the Service of Scribe?
(Please indicate by putting √ in the appropriate BOX)

Yes No

e. Do you belong to Religious Minority:

Yes No

8. (a) Date of birth (As per School Leaving Certificate SSC/ SSLC)

Date Month Year

(b) Age as on 01.02.2010:…………….Years………………Months

( c) relaxation in Age (if claimed): No of Years……………under category
9. Nationality:……………………….
10. Details of Application fees and Postage charges:
Name & address Name & Address of Date of issue Demand Draft/ Amount in Rs.
of issuing Bank/ Drawee Bank/ Bankers Cheque
Branch Branch No.

(Application Fee should be sent in the form of Demand Draft in favour of “Bihar Kshetriya Gramin Bank Clerical
Recruitment Project 2009-10” payable at Munger (Bihar)”. Fees for General and OBC candidates is Rs.300 and for SC/
ST/ PWD/ EXS candidates is Rs.50)
11. Pre-Examination Training (To be filled in only by those SC/ ST/ PWD/ Religious Minarity Community candidates, who
are desirous of taking Pre-Examination Training)
Are you desirous of taking pr-examination training?
(Please indicate by putting √ in the appropriate BOX)
Yes No

12. Place of Birth: Town/ Village…………………..Tehsil:……………………

District………………………….State:……………………..
13. Are you an Ex-serviceman?
Yes No

If yes, specify the following

i) Date of Discharge:………………………….
ii) Rank at present/ last held:…………………………….
a) Acting as:…………………………….w.e.f…………………………………
b) Substantive:………………… w.e.f…………………………………..
14. Are you divorced/ Judicially separated?
Yes No

15. Are you a candidate who had originally been domiciled in Kashmir Division of the state of J & K during the period of
01.01.1980 to 31.12.89
Yes No

16. Educational Qualification (From Class X onwards) (As on 01.02.2010)

Examination Name of the Subjects Month & % of Class/

Passed board/ Studied Year of Mark Division
University passing s
10th Std

12th Std

Graduation
Post
Graduation
 Others

(If space is not sufficient please attach separate sheet)

17. Languages known. (Please indicate by putting √ in the appropriate BOX)
S.No Language Read Write Speak

18. Particulars of Post ‘Qualification’ Experience including the Present Occupation/ Job.
Name of the Designation and Period of Length Nature of Remarks
employer(s) rank if any service of duties (Reasons
firm etc and the service performed for
nature and Years, in detail leaving
details of Months service)
activities , Days
carried out by From To
the employer

19. Are you a native/ domicile of Bihar? If yes, attach copy of domicile certificate.
Yes No

20. Center of Written Examination (IN BLOCK LETTERS)

CENTER CODE
21. Any other information:………………………………………
22. Before mailing application please check that you have furnished the following:
a) Category/ Sub-category and have enclosed copies of necessary certificates for SC/ ST/ OBC/ PWD/ EXS candidates.
b) Details regarding fees (Bank Demand Draft/ Bankers Cheque)
c) Address for communication:
d) Details for claiming relaxation in age and the relevant certificate is enclosed.
e) Two self-addressed unstamped envelopes of 11x5 size.
f) An attested copy of Domicile Certificate is enclosed.
g) The envelope is to be super scribed with the words “APPLICATION FOR THE POST OF CLERK-CUM-CASHIER,
Bihar Kshetriya Gramin bank Clerical recruitment Project-2009-10”

DECLARATION
I hereby declare that all the statements made in this application are true, complete and correct to the best of my knowledge
and belief. I understand that in the event of any information being found false or incorrect at any stage or not satisfying the
eligibility criteria according to the requirements of the relative advertisement, my candidature/ appointment for the said post is
liable to be cancelled/ reject at any stage and if appointed, my services are liable to be cancelled/ terminated. I have not been
debarred from taking up the test/ selection by any Bank/ IBPS and I have not been convicted in any criminal case. I am
willing to serve anywhere, if selected. I agree that the bank has the right to transfer me to any place 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 the said advertisement can be instituted by me only before the Courts/ Tribunals/ Forums at Munger and they also
shall have the sole and exclusive-jurisdiction to try any case/ dispute. I undertake to abide by all the terms 7 conditions
mentioned in the advertisement given by the Bank and other further communication/ intimation/ notification with regard to
this recruitment.

Place:
Date: Signature of the Applicant