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Self attested
Last Date of Receipt: 31st July 2020
3. Father/Husband’s name
Date of Birth(attach proof) Completed Age
Male Married
Years Months
4. Personal Details
Female Unmarried
…… …… …
Mobile Res Office Email:
7. Tele No. with STD Code & Email
………… ……… ……… ………
Permanent Address Correspondence Address
9. Address
11. Details of educational Qualification :(Attach copies of Certificates & Mark sheets starting with 10 th
)
% marks Year College/Institute/
Name of the Examination Main Subjects
& Division Passing University/ Board
16. Experience: (Attach detailed resume, Appointment / Relieving letters (as applicable) and Latest Salary Certificate )
Duration Designation &
Name & Address of the
Responsibilities
Organisation From To
Designation: Present Salary (per month)
a. M/s…………………
Duties:
Rs…………………..
………. Present
Designation
b. M/s…………………
:Duties:
…….. ……….
I hereby declare that the particulars furnished above are true and that my candidature/appointment will be
cancelled at any stage if any information is found to be false / incorrect.
Place Signature…………………………….
Date
Name…………………………………..