APPLICATION FORM

ADVERTISEMENT NO. RR SITE/HRM/01/2013

AFFIX YOUR RECENT SELF ATTESTED PASSPORT SIZE PHOTOGRAPH

01.

Code No.of the Post applied for Post applied for Subject / Discipline Candidates Name (in Hindi) First Name Middle Name Last Name Candidates Name (in English) First Name Middle Name Last Name Marital Status Fathers/Husbands Name Gender Date of Birth Category Whether belongs to Ex-serviceman category? Religion Nationality Physical Standard (For Post Sl.No.No. 12 to 14) Whether belongs to PWD category? If yes, please indicate the type of disability. Medium of written test Qualifications (only for Post Sl.No. 01 to 09 )
Educational Qualification Subject / Field / Branch

FOR OFFICIAL USE

Registration No... Date of receipt ...

02.

03.

04. 05. 06. 07. 08. 09. 10. 11. 12. 13. 14. 15. 16. (a)

Single Male Date SC Yes

Married Female Year OBC No

Month ST

General

Height Yes PH Hindi

Cms. HH

Weight No English

VH

Kgs.

Board / College / University / Institute

Entry Year

Year of Passing

Duration of the Course

Total Marks in %

SSC(10th) HSC(12th) Graduation Qualification in Computer Typing (Hindi/English) Stenography(Hindi/English)

(b)

Any Other Qualification

Subject / Field / Branch

Board / College / University / Institute

Entry Year

Year of Passing

Duration of the Course

Total Marks in %

17.
(a)

Qualifications (Only Post Sl. No. 10 to 14)

Educational Qualification Year of Passing Board / Institute Marks in % Science Maths Whether English is one of the subjects? (Yes/No) Duration of the Course Duration of the Course Total Marks in %

(b)

SSC(10th) HSC(12th) Technical Qualification (ITI / Diploma in Eng.) Any other Qualification

Subject / Field / Branch

College/University /Institute

Entry Year Entry Year

Year of Passing Year of Passing

Total Marks in %

(c)

Subject / Field / Branch

College/University /Institute

Total Marks in %

2 18.
Post Qualification Experiecne Name of the Organisation Post Place of posting Duration of Service From Date To Date Total Period of Service Job Details

19.

Whether candidate is working presently with any Central/State Govt., PSUs of Central / State Govt. (including NPCIL), Autonomous Body, Added Institutions or any Private Institution on regular basis. If yes, give full details. Whether candidate is registered with any Employment Exchange?

Name of Central/State Govt., PSUs of Central / State Govt.(including NPCIL), Autonomous Body, Added Institutions or any Private Institution Yes/No, if yes, write Registration No. : Name of Employment Exchange :

Post

Date of entry into service

20.

21.

State : Whether any close relative(s) of candidate is employed in Sl. Name of relative(s) NPCIL? if yes, please give full details. No.

Post

Site / Project

Relation with candidate

22.

23. 24.

Correspondence Address Name : Fathers/Husbands Name : Plot No. /House No. /Flat No. : Road/Street/Mohalla : Village/City : Tehsil : District : State : PIN Code: Contact No./E-mail ID Any other information candidates wish to provide.

Permanent Address Name : Fathers/Husbands Name : Plot No. /House No. /Flat No. : Road/Street/Mohalla : Village/City : Tehsil :% District : State : PIN Code: Mobile Number : Land Line Number : E-mail ID:

25.

List of enclosures

Note:Pleasetick()whicheverisapplicable.

Declaration by the Candidate

I declare that the above information is true and correct to the best of my knowledge. If anything found false in the above said information, my candidature shall be rejected at any stage of this recruitment and selection process and thereafter.

Place ..
Signature of Candidate

Date ..

Name of Candidate