City and Industrial Development Corporation of Maharashtra Ltd.

(A Government of Maharashtra Undertaking)

Recent
passport sized
photograph

1. Post applied for ___________________ _________________________________________

Name in full _______________________________________________________________
(in capital) (Surname) (Name)
Father’s/Husband’s Name
_____________________________________________________
(for married woman only)
2. Present Address with Telephone No., if any, ______________________________________
__________________________________________________________________________
Permanent Address with Telephone No., if any, ___________________________________
__________________________________________________________________________
3. Age ________Years, Date of Birth _____________________________________________
(Day) (Month) (Year)
Place of Birth ______________________________________________________________
Religion :_______________ Nationality :____________ Domicile:_____________
Marital Status:___________ No. of children:_________ Sex:___________
Identification Marks ____________________

4. Category - Open SC ST VJ(A)

NT(B) NT(C) NT(D) SBC OBC

5. Whether falling under (Non Creamy Layer / Creamy Layer ) - _______________

6. Whether belonging to CIDCO Project Affected Persons (PAP) - ___________
7. Whether working in CIDCO (Yes/No) - ___________

8. Full particulars of General and Technical qualifications :-

Name of Exam School/ Month and year Class/ Division Principal Merit/ Rank if
Degree of College/ of passing subjects offered any & % of
course University marks
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9. Physical fitness for the post of Security Guard:-

Height - ___________ cms Chest inflated - _____________ cms
(min. expansion should be 5 cms)
Weight - ______________ kgs Eye sight - ____________

9b. Are you Ex-servicemen (Yes / No) - ______________________

EMPLOYMENT DETAILS
10. Note : The following record is very important for considering you for employment. Cover
your activities, outlines in details for each employment period, your specific duties and
responsibilities, including employment record.
Sr. Name & Type of Period of employment Designation
No. Address of business of From To
employer employer

11. Details of pay order : ________________________________________________________

12. Mother tongue :_____________________________________________________________
13. Languages known: _______________________________________________________
14. Is there any of your relations working in this Corporation: ___________________________
If, yes, please state the name and relationship _____________________________________
15. Brief record of extra curricular activities, (sports, hobbies etc.) _______________________
__________________________________________________________________________
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16. Please name three references who are not your relatives and who can certify about your
work and conduct:
Sr. Name Occupation Postal address Years
No. known

17. Any other relevant information:- _______________________________________________

__________________________________________________________________________
18. “Whether the organization in which you are employed is Govt.
Undertaking/Department/Institution? If yes, please forward your application through proper
channel”.
19. I solemnly declare that all the particulars furnished in this application are true and correct to
the best of my knowledge and belief. I clearly understand that any misstatement of fact
contained herein or willful concealment of any material fact will render me liable to
appropriate action as may be decided by the Corporation.

Place ______________ Date _______________ Signature _____________________

Details of Documents attached :

(NOTE : Candidates should furnish alongwith this application true copies of certificates,
testimonials of educational qualifications, experience, caste certificate, caste validity
certificate, certificate of non creamy layer, domicile proof, etc. duly certified by Gazetted
Officer. Post for which the application is made should be clearly mentioned on the
envelope. Different applications should be given for different posts. Each application
should carry separate pay order of appropriate amount. Candidate working in Government
or Public sector should apply through proper channel.)