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APPLICATION FORM

ADVT. NO. 04/2019 DATED 22.05.2019

PLEASE AFFIX YOUR


RECENT PASSPORT
National Fertilizers Limited SIZE PHOTOGRAPH
(A Govt. of India Undertaking)

1. ALL ENTRIES SHOULD BE IN UPPER CASE/BLOCK LETTERS IN BLUE INK


2. CIRCLE THE APPLICABLE OPTION
3. CUTTING / OVER-WRITING SHOULD BE AVOIDED
4. CANDIDATES ARE ADVISED NOT TO CHANGE THE APPLICATION FORM PROFORMA

NAME OF THE POST APPLIED FOR


POST CODE

1. Name of The Applicant


2. Gender Male / Female / Others

3. Marital Status

4. Father’s / Husband’s Name

5. Mother’s Name

6. Date of Birth (as per Matric Certificate)

7. Age as on 30.04.2019

8 Mobile Number

9. E- Mail ID

10. State Of Domicile And Nationality


CONTACT / MAILING ADDRESS PERMANENT ADDRESS
11.

District : District :
State : State :
Phone No. (with STD Code) : Phone No. (with STD Code) :
12. Nearest Railway Station

13. Religion

Whether belongs to Minority Community


14. Yes / No
If yes, please state.
………………………………….

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APPLICATION FORM
ADVT. NO. 04/2019 DATED 22.05.2019

Were you domicile of J&K during the period from


15. 01.01.1980 to 31.12.1989? (Copy of Certificate to YES / NO
be produced at the time of Interview).
Circle the Category [copy of Certificate to be
16. produced at the time of Interview in case of SC / ST / OBC / GEN
SC/ST/OBC (NCL)].
a) Caste a) _______________

b) Sub- caste b) ________________

c) Non- Creamy Layer (for OBC only) c) Yes / No

Person with Benchmark Disability (PwBD) / YES / NO


Divyang? OH: OA, OL, BL, OAL or
17.
If Yes, circle the category of Disability VH: B, LV or
(OH/VH/HH) HH
Percentage:
a) Are you an Ex- Serviceman? Yes / No
If Yes, mention the last Rank held and the no.
of years completed in the Rank. ………………………………
18.
b) Are you Serving Officer in the Armed forces? Yes / No
If Yes, mention the present Rank and the no.
of years completed in the Rank. ………………………………
Whether dependent of those killed / severely
19. Yes / No
disabled in action
Have you been interviewed by NFL any time
20. earlier? Yes / No

If Yes: ………………………………..
Post for which interviewed for:
………………………………..
Date of Interview:
Venue of Interview: ………………………………..

21. Are any of your relatives working in NFL?


Yes / No
If yes, provide details of Name, Designation, Unit,
………………………………..
etc.
.……………………………….
Are you a Departmental Candidate?
Yes / No
22. If yes, mention your E. No., Designation and
……………………………….
Place of Posting.

Employed in Central Govt. / State Govt. /


Central PSU/ State PSU / Autonomous Body /
23. Employment Status as on 30.04.2019.
Statutory Body / Public Limited Company / Law
Firm or Own Practice

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APPLICATION FORM
ADVT. NO. 04/2019 DATED 22.05.2019

I certify that I have not been arrested,


prosecuted, kept under detention or fined, FIR
Yes / No
filed in any Police Station, convicted by the Court
24. of Law for any offence debarred / disqualified by
If No, all relevant details to be enclosed in a
any Public Service Commission from appearing
separate sheet with records.
in its examination or if proceedings are pending
against him in any Court of Law
During your employment, whether any Yes / No
punishment / penalty were awarded to you or any
25.
vigilance case pending as on 30.04.2019 or on If yes, all relevant details to be mentioned in a
the date of application? separate sheet & enclosed with records

26. Identification Document Enclosed and Number

27. Educational & Professional Qualification (Graduation & above):

Nature of the Duration


Aggregate
course (Full of the Class/ Year of
Qualification Institute / University % of
Time/ Part Time/ course Division Passing
Marks**
Correspondence) (in years)

** In case of CGPA, conversion formula from CGPA to percentage to be enclosed mandatorily.

28. Details of Training Undergone in the last 5 years:

Institution / Duration of the Training


Name of Program
Organization From (DD/MM/YY) To (DD/MM/YY)

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APPLICATION FORM
ADVT. NO. 04/2019 DATED 22.05.2019

29. Post Qualification inline Professional Experience


from First Job onwards to Current Job (Chronological order):

SI. Name of the Type of Type of Designation Date IF EMPLOYED Detailed Job Profile
No. Organization Organization Employment From To Pay Scale or CTC (`)
(Central Govt. / State (Regular / (dd/mm/yy) (dd/mm/yy) (whichever is applicable)
Govt. / Central PSU/ Contractual / as on 30.04.2019
State PSU / Ad-hoc /
Autonomous Body / Temporary /
(Attach Proof)
Statutory Body / Public Training)
Limited Company /
Private Limited)

If required, additional sheets may be used & attached.

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APPLICATION FORM
ADVT. NO. 04/2019 DATED 22.05.2019

30. No. of years of Post Qualification Inline Experience as on 30.04.2019 __________ years.

For candidates employed in Central Govt. / State Govt. / Central PSU/


State PSU / Autonomous Body / Statutory Body as on 30.04.2019:

Type of Organization:
Scale of Pay:
31. Basic Pay:
DA: IDA or CDA DA rate as on 30.04.2019:

Scale of Pay as on 30.04.2018


Scale of Pay as on 30.04.2019
32. Date of Seniority (From Date in Present Grade / Post):
For candidates employed in Public Limited Company / Private Limited,
33. `
CTC (in lakh p.a.) as on 30.04.2019
35. If selected, how soon can you join (in days / months)?
Have you availed VRS from any PSU? Yes / No
36.
If yes, please mention the details: ………………………

37. Details of Application fee, if applicable:


Name of the Bank and Issuing Branch Address DD Number DD Date Amount

`700/-
I have carefully perused the advertisement No. 04/2019 and certify that the information furnished above is
correct to the best of my knowledge and no material information relevant to my candidature has been
suppressed or falsely declared and copies of self-attested documents in support of my candidature are
enclosed. I am meeting all the advertised specification for the post applied for. I understand that if the
information furnished by me is found to be incorrect/false or not supported by documentary proof, my
candidature will not be considered, even after short listing and no queries will be entertained by NFL. I fully
understand that canvassing in any form at any stage will render my candidature ineligible.

Date: Signature of Applicant

Place: (Name)

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