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Application Form:

Application format for post- . . . . . . . . . . . . . . . . . . . . . . .( under the Uttarakhand CAMPA)

Attach recentPassport sizephotograph of theapplicant

Personal History Form Date received(or !ffice Use onl")

Instructions: Please ans#er each $uestion clearl" andcompletel". %"pe or print in ink. &ead carefull" andfollo# all directions. &eturn under sealed cover toChief Executive Officer(Uttarakhand CAPA! "# $andir ar% &asant &ihar Enclave$ 'ehradun)*+,,-Uttarakhand

Indicate .itle of Post a//lied for:

A//licant 0ame

First 0ame iddle 0ame 1ast 0ame"2urname

Father3s" Hus4and3s0ame

(') Address at #hich "ou reside at present (indicatesince #hen)

() Permanent residence (if different from A)

%elephone um*er

Mo*ile um*er +

%elephone um*er :

Mo*ile um*er

a, num*er a, um*er

'-Mail Address + '-Mail Address

Date of irth(da"month"ear)

Place of irthCountr" of *irth ationalit" (no#) Previous nationalit" (if an")

'e/endent5s name 'ate of 4irth 6elationshi/

Communication a4ility:

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no#ledge oflanguages list mother-tongue first

&'AD /&0%' 1P'A

',cellent 2ood air 1light ',cellent 2ood air 1light ',cellent 2ood air

3indi

'nglish

Com/uter 2kills Excellent " 7ood " Poor " 0o 8no9led%e

M1 /ord

M1 ',celPo#er Point Presentation

%all" Accounting 1oft#are

0nternet

3indi %"ping

'nglish %"ping

An" other(Plz 1pecif")

Education : 2ive details in chronological order from 3igh 1chool on#ards. 0nclude short courses and postgraduatestudies in "our professionaloccupation and related field.

rom %o ame of schoolcollegeuniversit"or e$uivalent4 cit"countr"

',amPassed

1u*5ect 6 marks CertificateDiplomaDegree o*tained

Em/loyment 6ecord: 1tarting #ith "our present or most recent position4 list in reverse order positions held. Attachadditional pages if re$uired+

ame and address ofemplo"er

Positionheld

Period Monthl"&emuneration

&s.

Description of duties and responsi*ilities

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Personal 2ummary: Please indicate the relevance of "our e,perience and a*ilities7 #hat has *een the most significantfactors in "our career to date7 "our most useful achievements and contri*utions7 an" long-term plans for "our development/e #ould also like "ou to descri*e *riefl" "our activitiesho**ies outside kno#ledge #hich have not *een sufficientl"highlighted so far and finall" and circumstances4 disa*ilities4 health pro*lems or reservations4 #hich restrict "ourtransfera*ilit"4 mo*ilit" or travel.

1e%al Convictions$If any: 0f "ou have ever *een found guilt" of the violation of an" la# (other than minor trafficviolations)4 give particulars.

Charge Date /here tried Conviction

Other details"Information:

/hen are "ou availa*le to take up the appointment8

Documents to *e enclosed #ith the application+9. Photocop" of 3igh 1chool Certificate:. Photocop" of 0nter certificate;. Photocop" of 2raduation4Postgraduation4Diploma DegreeCertificate.. Mulnivas praman patra?. @oter 0D

0 certif" that the statement made *" me in ans#er to the foregoing $uestions and the photocopies of the $ualifications ande,perience certificates are true4 complete and correct to the *est of m" kno#ledge and *est understand that an" falsestatements or an" re$uired information #ith held from this form ma" provide grounds for the #ithdra#al of appointmentand dismissal even if an appointment has *een accepted.

Date 1ignature------------------------------------------------------------

ame +