Personal Details Format

NUCLEAR POWER CORPORATION OF INDIA LIMITED

(A Government of India Enterprise)

Application No. : __________________

GATE-2017 Reg. No. : __________________

Discipline : __________________

Ref: Advt. No.: NPCIL/HRM/ET/2017/01

Affix recent
Passport
size
Photograph

1. Name in full : ____________________________________________

(in Block Letters)

2. Date of Birth : _______________________

3. Marital Status : Single/Married

4. Nationality : _______________________________

5. Address (If any change) :

(a) Present Address (b) Permanent Address

____________________________ ___________________________

____________________________ ___________________________

____________________________ ___________________________

(b) Tel. No. (R) : ________________ (O) ___________________________

Mobile No.: _________________

E-Mail ID : ______________________

6. Details of relatives employed in NPCIL/Department of Atomic Energy or its

constituent Units.

Name of Relative (S) Relationship Unit in which Post Held

Employed
7. (a) Whether the candidate has ever served in the Central/State
Government/PSU or any other organization? Yes/No
(b) If yes please furnish the following details:-

Name of the Post Held From To Responsibilities

Organization

8. Please furnish the below details of two responsible persons of your locality or
two references to whom you are known : -

(a) Name _________________________ (b) Name _______________________

Occupation ___________________ Occupation __________________

Off. Address __________________ Off. Address _________________

_______________________________ ______________________________

_______________________________ ______________________________

Res. Address __________________ Res. Address _________________

_______________________________ ______________________________

_______________________________ ______________________________

Tel No. ________________________ Tel No. _______________________

Mob. No. ______________________ Mob. No. _____________________

Declaration

1. I hereby declare that all the above statements are true to the best of my
knowledge and belief.

2. I am aware that my candidature is liable to be rejected at any stage if the

information given above is incomplete or incorrect.

Date : ________________________ Signature : _____________________

Place : ________________________ Name : _____________________