a) Name of the post applied for :

(b) Name :
(c) Father's/Husband's Name :
(d) Address - Permanent & Correspondence :
(e) Phone/Mobile No. :
(f) Email ID :
(g) Age & Date of Birth (with supporting document) :
(h) Religion :
(i) Caste (Certificate in case of SC/ST/OBC) :
(j) Physically Handicapped (with supporting document) :
(k) Married or Single :
(l) Educational and Professional Qualifications beginning with Matriculation/equivalent along with year of
passing, % of marks, division/class obtained, subjects taken indicating Board/University (Self-attested
Documents to be enclosed) as per the format below : :
Educational and
Professional Qualification

Subjects
taken

Name of the
Board/University

Year of
Passing

% of marks
obtained

Divn./Class

(m) Details of experience including names of organizations, position held/nature of duties

with duration along with basic pay/allowances drawn mentioning pay scales (previous and
present) (enclosing supporting documents) as per the following format and last pay drawn
certificates :

Name of
Organisation

Date :
Place :

Position
held

Tenure of service

Nature of
From
To
duties
DD/MM/YY DD/MM/YY

Pay Scale, Basic Pay &

Allowances drawn

Signature of the Candidate