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APPLICATION FORM Attested

NOTE : Please fill this form in Capital letters Passport
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1. Name of post :

2. Name of District (applied) :

3. Name :
4. Father's / Husband Name :

5. Present Address :

6. Permanent Address :

7. Phone No. (with STD Code) :

Mob. No. 1 : Mob. No. 2 :
8. Date of Birth : / /
9. Details of DD :
DD No. : Date: / / Amount:
Bank :
10. Are you permanent resident of Haryana? Yes No
If Yes then name of District:

11. Are you already working in this project? Yes No

If yes then fill the School name & Code:
12. Kindly fill the school code as per your priority:
Priority 1 Priority 2 Priority 3
13. Educational qualification :
S. Pass out Examination Board/university/organization Passout year Received marks Division Attached
No. Name Name / Total marks Document(Y/N)
1 Higher Secondary
2 Graduate
3 Post Graduate
4 Degree in Computer
Education/Diploma
14. Experience / Details of work
S. No. From To Organization Designation Work description Attached
/Company Name Document (Y/N)

Declaration
I hereby declare that I am not involved in any illegal activity which neither effects the operations of this project nor in
future will be involved in illegal activity which affects this project. All the details in this application form are true and best of my
knowledge. In case of any false information NICT management is having a right to cancel the application and authorized for legal
proceedings against me and my application form will be treated cancelled. Regarding the application form the NICT
management decision will be final and I will be abiding with decision.
Any recommendation from the staff members and from other sources the application form will not be accepted and it
is been treated as a false practice.
Date:
Place: Signature