Annexure-I
ODISHA MINING CORPORATION LTD
APPLICATION FORMAT FOR RECRUITMENT
Affix recent
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1. Post applied for :.............................................................................................
photograph.
2. Advertisement No. and date: Advt No 72/OMC dated 21.10.2022
3. Full Name (In capital):....................................... .......................................
4. Father’s /Husband’s Name:.........................................................................
5. Date of birth :..........................................................................
(As recorded in HSC or equivalent exam) (Attach copy of certificate)
6. Age as on (30.09.2022) :..............................
7. Sex :……………………………………
8. Category :………………………………….
9. Marital status: (Married/Un-married) ........................................................
10. Address (with PIN code):
Present Address Permanent Address
11. Contact details: (a) Phone …………………………………………
(b) e-mail ………………………………………….
12. Qualification: (10th onwards) (Attach copy of certificates).
Sl. Exam Name of the Board Duration Whether Year & Maximum Marks % of
/ University / of course Regular month marks obtained
No. passed/ Institute course of Marks/
discipline (Yes/No) *
Passing CGPA
(*In case of CGPA/grades, please indicate equivalent percentage as per norms adopted by the University/
Institute & attach a copy of such norm fixed by the concerned University/Institute)
13. Post Qualification Experience (By clearly mentioning the date of joining & date of leaving/ continuance in the
organization(s) worked/working. Further, the positions held by the candidate in each organization
worked/working to be specified clearly):
Sl. Name & Post Scale of Cost to Duration of Total years Type of assignment
address of held Pay and Company & months handled/specific
No. Basic Experience of nature of work/duty
Organizations Pay (CTC) experience performed.
worked (DD/MM/YYYY)
Date date of
of leaving/
Joinin continuance
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Note: Copy of the experience certificate (s) as per the above particulars must be attached.
14. Whether applied earlier in OMC, if yes, please mention the posts applied for……………………………
15. Whether appeared for Personal Interview in OMC, if yes, please mention the post appeared for…………………...
16. No. of days/months required to join, if selected:………………………………..
DECLARATION
I .............................................Son/Daughter/Wife of ................................................., do hereby
declare that all the statements made in this application 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 without any notice to me.
(SIGNATURE IN FULL)
PLACE: ............................ NAME: …………………………………………….
DATE: ............................
NB: Documents/Certificates to be attached (Please put √ mark) :-
1) 10th Certificate
2) 10th Mark sheet
3) +2/ Intermediate Certificate
4) +2/ Intermediate Mark sheet
5) Degree Certificate
6) Degree Mark sheet
7) Post-Graduation Certificate
8) Post-Graduation Mark sheet
9) Proof of CGPA to Percentage conversion formula
10) Relieving/ ContinuanceCertificate if applicable
11)
12) Experience Certificate (s)
13) Caste/ Class Certificate
14) PwBD Certificate
