Application for Recruitment in Pay Band-1 (Rs.5200- 20200) + Grade Pay Rs.

1800 in Northern Railway Annexure -1

Railway Recruitment Cell / Northern Railway For Office use only:

Employment Notice Number – 220-E/Open Mkt./RRC/2010 Control Number:
Roll Number :

1. Category / Post applied for: (Indicate your order of priority / choice in the box below).
You will be considered for the posts applied only. Paste (do not pin or
Option / Category Name of the Post Option / Category Name of the Post staple) here your recent
preference Number preference Number colour passport size photo
1. 4. (The photograph shall not
2. 5. be more than 3 months
3. 6. old.)

2. Name of Candidate :

3. Father’s name: Sh.

4.Date of Birth: Age Y Y M M D D

Signature of the candidate
(DD/MM/YYYY): :
5. Community: ( Tick  ): SC S O U 6.Are you Physically VH H O
T B R Disabled: H H

7. Address for communication:

8. Nationality

9. Religion

PIN P H O N E 10. SEX

12. Nearest railway Station:
( In English only for issue of free 11. Marital Status
railway pass for SC /ST candidates)

13. Visible Marks of Identification : 1.

( moles etc on your body) 2.

14. Do you seek age relaxation under any of the category mentioned below? ( Tick  appropriate box)
SC ST OB Physically Disabled Course Completed Judicially separated / Railway Employee
Act Apprentice divorced woman / widow

15. Educational Qualifications:

Qualification University / Board Year of passing % of
marks
SSC / 10th class
ITI
Others
16. List of Documents enclosed: (fill in the details of the copies of certificates / documents enclosed.)
i) iii) v)
ii) iv) vi)

17. Details of IPO /Demand Draft enclosed with the application: 18. Choice of Language for written examination:
Name of the Post office / Bank Serial Number & Date Amount

19. Declaration by the candidate: (copy the passage in the box below in your own hand writing):
I hereby declare that all the particulars given above by me are true and to the best of my knowledge. I am aware that in the event of any information
furnished by me is found false / incorrect at any stage, my candidature will be rejected summarily and I am also liable for criminal action. I will abide
by the instructions given in the notification.
Place:

Date: Left hand Thumb Impression Signature of the applicant