MILITARY ENGINEERING SERVES APPLICATION FORM

1. (a) (i) (ii) (iii) (iv) (b) Post applied for (Trick One Only):Store Keeper-II Peon Chaukidar Chaukidar (Khasnsama) MATE ONLY:(i) MATE (Specify Trade Applied).. (ii) 2. 3. 4 5. Area for which applied for:- Paste resent photograph duly self attested, passport size Dont staple

Name of the candidate:Sex:- (Write M for Male and F for female) Fathers Name:(a) (b) (c) (d) Candidate date of birth (In figure):DD MM YYYY Candidate date of Birth (In words):Age as on 20 Jan 2012:-________Years_________Months________Days Whether candidate seek for age relaxation:(Write Y for Yes and N for NO in the box) SC ST OBC DIV/SEP DEPT Permanent Address:-

EX-SER

6.

D I S T R I S T A T E : 7.

C T : P I N :

Address for communication:-

D I S T R I S T A T E :

C T : P I N :

8.

Qualification as on 20 Jan 2011(Mention all educational Qualification starting from Matriculation):Name of the Name of the Board/University Year of % of Examination Passing Marks

Division

9.

Please tick appropriate boxes against column as applicable:(a) Religion (if other than pls also mention (Hindu/Muslim/Sikh/Christian):(b) Nationality:(c) Category:SC ST OBC Yes (d) (d) Whether Phy handicap:Yes (e) Whether Ex-Serviceman:Yes (f) (g) Whether Serving in MES:Whether Serving in other than MES department:Yes Duration Year Month Salary Drawn No No No

GEN

No

10.

Experience in the subject field of selection:Name of the Length of service Organization From To

11. 12. 13. 14. 15.

Identification Mark of the candidate:(a) (b) Whether you are debarred or disqualify from any of their examination/selection:Whether you have ever been convicted by any court for any offense:Do you have any relative working in MES Department:Yes Yes No

Yes No

No

If yes, give Name, Post, Relation and Official Address of the relative:-

Note:- Admit Card for written test and interview and declaration as attached to be filled and send with the application

Place:Date:-

(Signature of the candidate) Name of the candidate in capital letter:-

DECLARATION 1. I have not submitted other application for this examination. I am aware that if I contravene this rule, my application will be rejected summarily by the department. 2. I have read the provision in the Notice of the examination carefully and I hereby under take to abide by them. 3. I further declare that I fulfill all the condition of the eligibility regarding age limits, educational qualification etc prescribe for submission to the examination. I have enclosed photo copies of following certificates in support of my claim for education, age, category (SC/ST/Ex-SM/OBC/PH) and age relaxation:(a) (b) (c) (d)

4. I hereby further declare that all statement 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 suppressed/ false or incorrect or ineligibility being detected before or after examination, my candidature/ appointment is liable to be cancelled.

Place:Date:-

(Signature of the candidate) Name of the candidate in capital letter:-

ADMIT CARD FOR WRITTEN TEST

TO BE SUBMMITTED IN DUPLICATE ON SEPRATE SHEETS IN DOUBLE SPACE

(Serial No. 1,2,3, only will filled by the candidate) (Without Admit Card candidate are not allowed to attend the written test) Admit Card No. (To be filled by issuing Authority) 1. 2. Name:-.. Full Address:-. PIN Code. For Official use only:3. 4. 5. 6. Post applied for:-. Date of Written Test:- Time of Written Test:- Venue of Written Test:-. Candidate/ Office Copy Paste resent photograph duly self attested, passport size Dont staple

Date and Signature of the Applicant:-.

(Signature of Issuing Officer with Stamp)

ADMIT CARD FOR PRACTICAL TEST/INTERVIEW

TO BE SUBMMITTED IN DUPLICATE ON SEPRATE SHEETS IN DOUBLE SPACE

(Serial No. 1,2,3, only will filled by the candidate) (Without Admit Card candidate are not allowed to attend the Practical test/interview) Admit Card No. (To be filled by issuing Authority) 1. 2. Name:-.. Full Address:-. PIN Code. For Official use only:3. 4. 5. 6. Post applied for:-. Date of Written Test:- Time of Written Test:- Venue of Written Test:-. Candidate/ Office Copy Paste resent photograph duly self attested, passport size Dont staple

Date and Signature of the Applicant:-.

(Signature of Issuing Officer with Stamp) Note:-

(a)

6 All documents/testimonial in original regarding Date of Birth, Category, Qualifications, Experience etc. will have to be produced at the time of appointment, failing which the candidature is likely to be cancelled. Draughtsman should bring their drawing Board, Instruments and Pen-pencil etc. Other candidates should bring their pen-pencil, clip board etc.

(b) (c)