APPLICATION FORM
1. Name of the Post Applied for: .………..……………………………………………………………………….…….
Paste your recent passport
size photograph
2. Full name of the Candidate: …………………………………………………………………………………………..
(In Capitals Letters) ...…..………………………………………………………………………………………
3. Date of Birth:
Day Month Year
4. Gender: (Write ‘1’ for Male, ‘2’ for Female)
5. Marital Status: ………………… 6. Social Category: 1. General [Link] [Link] [Link] [Link] [Link]
7. Father’s/Husband’s Name…………………………………………………………………………………………………………………....
8. Present Address (In Capitals Letters): ……………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………………………………...........
Block: ………………………………. District: ………………………………….. State: ………………… Pin Code: ………………………..
9. Permanent Address (In Capitals Letters): …………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………………………………...
Block: ……………………………………. District: ………………………………….. State: ……………………………………………….
Pin Code: …………………… Mobile: ………………………………………………. Residence Mobile: …………………………….
Email ID (if any): …………………………………………………………………………………………………………………………………
10. Nationality: …………………………………………………………………………………………………………………………………………
11. Choice District Name …………………………………. Block-1…………………………………………………………………………..
Block -2……………………………………………………… Block-3……………………………………………………………………….....
12. All Educational/other professional Qualifications/Training Courses etc/Degree Examination Onwards:
Sr. No. Educational qualification Year of University/ Maximum Marks %age
passing Board Marks obtained
1
13. Brief professional experience:
Name of the
Designation Duration Nature of Duties
Employer
Total Period (in years)
Form To Years Months Days
I –––––––––––––––––––––––––––––––––––––––––––––––––––hereby declare that the particulars furnished by me in
this application form are true to the best of my knowledge and belief. In case any information is found to be
incorrect, my candidature shall liable to be rejected.
Date:
Place: Signature of candidate
