anos 164.100 43.106 soe0epeblappicantinitial phpPide 18979 w APPLICATION FORM Ss 1. Post applied for Scientist 2. Advt.No (05/2015-Admn (R),17-23,00,2015 3. Name of the candidate (In Block letters) DIBYASINGH MAJH! 4, Father! Husband's name Pitharath Majhi 5. Date of Birth (in Christian era) Age in Years, Months & Days 14-05-1901 6. Whether belongs to SC/STIOBC/UR/PwD/Ex.S.Man ste 7. Nationality Indian Jo PN. WOT |AT-WARD NO.23, NEAR GOSALA CHAK, TULASTCHOURA, “BARTPADA 8. Present Postal Address with pin code For correspondence in block letters [aT = DISTRICT POLICE OFFICE, = SSUBARNAPUR. ® IN’ - 767617 9. Correspondence Address with pin code in block letters POSTAL CODE | 767017 STATE Orissa 10. PHONE NO. 9437621999 MOBILE NO | 9437621000 14, E-mail 1D «maPi930@ gmail.com 12. Educational Qualifications (lOth /olass onwards) Name ofthe Name othe | Year ot ot Touision| _SubieevDiscipne in Engineering or S40] examnatonPessed | Passing | (200%! |manaiccra | OM Sence/Ote: ; Englsh Comm. Gia, Mas, S&T, Soa 1 ‘oth nooe | case | ssa | ta a ONSE Physics Ghenisty Maths Biology Englsh MIL 2 ‘ath zooe | SESE | seen | 13 vat PoPM 3 sreen — | 2orz | trom | 66% | tat. | etectonies and Communication Engheerng Jabalpur rtp 164,100 49,188:8080\opcbapplicarirital pho?id= 18673 weanos 184.100 43.106 soe0lepeblappicantintial phpPide 18979 13. Details of Employment (Work Experience). any. Name of the Pay Band with Postheld | From To Grade Pay and | Nature of duties Officellnstt/Orgn, Basic pay Bharat Electronics Limited Deputy Rs 16400- | Testing & Customer Ghaziabad Engineer | 1126/2012 | 1107/2014 | 35, 40500 support Total Experience in Years | Months /Days. (01 Years [11 Months 414, Additional information, if any, which you would like to mention in support of your suitability for the post. Enclose a separate sheet if the space is insufficient. Declaration | affirm that information given in this application is true and correct. | also fully understand that if at any stage itis discovered that any attempt has been made by me to conceal willfuly or misrepresent the fact(s), my candidature may summarily be rejected or employment terminated. Place |Sonepur Date 02-11-2018 rtp 164,100 49,188:8080\opcbapplicarirital pho?id= 18673 Ox 22