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Present Address:
(Contact Ph/Mob.__________________________________)
Place of Birth: Village: ______________________ District _________________________ State ___________________
Date of Birth: __________________________ Age: ____________ Years __________Month
How soon can you join duty, if selected? Minimum total emoluments acceptable
Hove you ever been dismissed / discharged / terminated for any act of misconduct in any of your previous employment or
convicted for any criminal or other offence? Yes / No ________
If yes, give compact and precise details on a separate paper
1.
2.
Extra curricular activities (Proficiency in Sports / Games (if any), Hobbies, etc
Any other relevant information in support of your application, e.g. Membership of professional organization, research
papers, articles and any other publication and merit awards, etc (use separate sheet, if required)
Declaration
A. Should any information stated by me in this application be found incorrect, my employment with Company is
liable for immediate termination without payment of any compensation thereof.
B. I declare that I had no previous conviction.