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Advertisement No Application form
7568 Application form for the post of No ………….
dated 12 -06-2019 CGM/GM (for office use only)

Recent coloured selt

attested
P.P. size photo graph

1. Name of the post (please tick Applied for) : CGM GM

Name of applicant
2. (Capital letter) :. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Name) (Surname)
3. Father's name : ………………………………………………………………
(Name)
(Surname)
4. Parent Department : ……………………………………………………………….
(With full Address)
…………………………………………………………………
…………………………………………………………………

5. Permanent address : ………………………………………………………………

………………………………………………PIN………….
6. Present address : ………………………………………………………………
………………………………………………PIN………….:.
(Address proof : Enclosure 1)
7. Date of birth :. . . . /. . ../ . . . . . . . (In words …….. . . . . . . . . . . . . . . . . . . . .)
(Attested true copy of mark sheet of Higher Secondary School Certificate Examination /equivalent
examination exhibiting date of birth : Enclosure 2)
8. Age as on the date of Advertisement : …………… Years ………… Months …………. Days

9. Category (Please tick) : Unreserved/ OBC/ SC/ ST

(Self attested true copy of caste certificate in case of OBC/SC/ST candidate : Enclosure ….3)

10. Home district (Attach front

page of Service book for proof) : ………………………………………………………………
11. Educational qualification details :
(1) Post Graduation : Degree . . . . . .. .. . Specialisation in ……………………….
(2) Graduation : Degree . . .. . . .. . . .Subject …………………………………
(3) Others (Diploma etc.) : Description ……… . .. . .. . . . . . . . . . . .…………………….

12. Service and experience details :

(a) Parent Department : ……………………………………………………………….

(b) Details of organization :…………………………………………………………………..

(c) Present Post :. …………………………………………………………………………….

 (d) Address of the present office:. . . . . . .. . . . . . . . . . . . . . . . . . . . . . ………………..............

(e) Designation at first posting : . . . . . . . . . . . . . . . . . . . . . . . . . …………………………....

(f) Present pay :. . . . .. . . ……………... . . . . . ……………….. . . . . . . . . . . . . . . . . . . . . …..

(As per present applicable pay rules)
(e.g. pay in the pay band and grade pay in revised pay structure)
(g) Post wise experience (as on date of publication of advertisement)
S. Name of Post from date field work office work
N. …………to experience Years experience
date ……….… . . . . . Months . . . Years . . . . .
Days…… Months . . .
Days……
1

(H) Total length of service (As on date of publication of advertisement)

:.. . . . . ..Years . . . . .Months . . . . . Days.
(I) Total length of Service in field (As a Assistant Engineer)
:.. . . . . ..Years . . . . .Months . . . . . Days.
(J) Total length of Service in field (As a Assistant Manager in MPRRDA with original post
Assistant Engineer in parent department)
:.. . . . . ..Years . . . . .Months . . . . . Days.
(K) Total length of Service (As a Executive Engineer)
:.. . . . . ..Years . . . . .Months . . . . . Days.
(L) Total length of Service (As a Superintending Engineer)
:.. . . . . ..Years . . . . .Months . . . . . Days.
13. PAN (if available) : ……………………………………..
(Attested true copy: Enclosure . . . )
14. Cell phone no. : ……………………………………..
15. Email ID : ……………………………………..

(Signature of applicant)
Name of the applicant: . . . . . . .. . . . . . . . . . . . . . . .

2
 Declaration
I hereby declare that no criminal proceedings /Departmental enquiry of any nature is pending
against me. I further declare that information supplied by me in, the application form and its
supplementary parts and enclosures annexed to it; are true to the best of my knowledge & belief. My
selection to the post may be cancelled and suitable action may be taken, if information furnished by me an
Application form is found false or incorrect at any point of time in future. I already inform to my parent
department for permission.

Date :. . . . . . .. . (Signature)
Place :. . . . . . .. . Name of the applicant: . . . . . . .. . . . . . . . . . . . . . . . .
Encl –