Pashchim Gujarat Vij Company Limited

Affix self
Photograph APPLICATION FORM attested
Photograph and
VIDYUT SAHAYAK (JUNIOR ASSISTANT) taken recently

NOTE:-PLEASE SEND YOUR APPLICATION FORM THROUGH REGD POST ONLY

Name Mr./Mrs./Miss

Name Middle Name Surname

Address

Phone No With STD Code Mobile No.

Email Address :

Birth Date Caste

DD MM YYYY (UR/SEBC/SC/ST)

Age as on 26.08.2010 Sex M F

YRS MTHS DAYS Marital Status: Married / Unmarried
Whether PH or not?_________ if yes, than by which part of the body__________ % __________
EDUCATIONAL QUALIFICATIONS:
Whether
Name of Passing Regular / Marks Out of %
Name of Degree Duration
University Year External/ obtained
Part time

Other Qualification: (Computer Degree or other)

Sr.No. Name of Exam Degree Year of Passing Name of University

Experience (If Any)

Period of Service Total Experience
Name of Organization Designation
From Date To Date in year/Month

1. Whether you are working in GUVNL or any subsidiary company of it or not? : _________
2. If yes, than name of the company: _______________________________________________

I hereby certify that the information submitted by me in the application is true, complete and
correct to the best of my knowledge and belief. I further understand that if any information
given herein above is proved false then I am liable for being removed from the services of the
Company. I also certify that. No criminal Proceeding is initiated / Pending against me and I have
never been convicted by any Court of Law.

I have submitted herewith attested copies of following documents serially: (Please Tick √)
1. Two Passport size Photograph (To be pasted on Application Format).
2. School Leaving Certificate. (For Birth Day verification, SLC is must).
3. Copy of Mark Sheets (Graduation / Post Graduation / computer).
4. Degree Certificate.
5. Caste Certificate (Please attach latest creamy layer certificate for SEBC candidates)
6. Medical Certificate (For Physical Handicapped Candidates).
7. Any Other certificate. (Please specify).

Date SIGNATURE OF THE CANDIDATE