Annexure A

APPLICATION FOR SELECTION AS RESEARCH OFFICER (CHEMICAL /

MECHANICAL/METALLURGY) IN
INDIAN OIL CORPORATION LIMITED, R&D CENTRE, FARIDABAD

Name of the College / Institute : ________________________________

Recent
Course of Study : ______________ Engg. Discipline: ___________________ passport
(M.E/ M. Tech) size
photograph
Month/Year of Commencement: ____________ Month/Year of Completion of the
Of the course to be affixed
course: ____________________

Name of the Candidate (Mr. / Ms.) :

_________________________________________
(in Block Letters)
Fathers Name :
_________________________________________
Address for Correspondence :
_________________________________________

__________________________________________

Permanent Address :
__________________________________________

___________________________________________

E-mail Id :
__________________________________________

Telephone No. with STD Code / Mobile No :

____________________________________________

Date of Birth : ___________________ Nationality :

___________________

State of Domicile : ___________________ Religion :

___________________

Category : ____________________ Name of :

____________________
(SC/ST/OBC/General) Caste/Tribe

For OBC, Entry No. in Central List: _______________

Whether Physically Handicapped : Yes No No

If yes, please specify type of disability : VH / HH / OH & ______ % of

Disability
EDUCATIONAL QUALIFICATION (Starting from Class X):

Examination Subject/ Board / Year % of marks Class /

Discipline Univers of obtained / Rank
ity Passi CGPA obtained
ng

Aggregate % of marks / CGPA obtained in ME/M.TECH :

___________________
upto the end of the last semester completed
(indicate the semester)
::2::
Project Work :

Title Brief Outline Year

Work Experience (if any) :

Industry / Company Assignment Period

Areas of Interest or Any other information that you may like to furnish:

__________________________________________________________________________________

__________________________________________________________________________________

I am enclosing the following documents:

Documents Please Indicate Yes /

No / Not Applicable
Copy of the School Leaving Certificate indicating
date of birth
Copy of the Caste Certificate issued by the
Competent Authority
(applicable for SC/ST/OBC candidates only)
Disability Certificate issued by the Competent
Authority
(applicable for Physically Handicapped candidates
only)
Class X & XII Mark sheets
Semester Mark sheets
I hereby certify that the particulars given above are true to the best of my
knowledge and belief. If any of the information is found to be false or incomplete,
the Corporation will be at liberty to cancel my selection / appointment or
terminate my training / service.

I certify that I have read and understood The guidelines & criteria for Physical
fitness for pre- employment medical examination.
Date : __________________ Signature of candidates :
______________________

Place : _________________ Name :

____________________________________