Proforma of Application for the post of ----------------------------------

1. Name of the applicant :

2. Father’s Name :

3. Date of Birth :

4. Present Communication address :

5. Permanent Address :

6. Category (Gen/OBC/SC/ST) :

7. E-mail ID :

8. Tel/Mobile No. :

9. Name of Present Organization :

10. Present Pay Scale and Basic Salary :

11. Educational qualification (in reverse chronological order starting from latest

qualifications)(submit self-attested copy of testimonials)

Sl.No. Qualification University/Institution Year Percentage of

marks/ CGPA

Main

Subjects/

Specialization

12. Service Particular/Professional Experience

Sl.

No.

Designation Name of the

Department/office/

Organization

Place of

Posting

Duration

(mm/yyyy)

Pay Scale/

Emoluments

Job Profile

From To

Self-attested

recent

Photograph

13. Additional information, which you would like to mention in support of your suitability for the

post. Enclose a separate sheet if the space is insufficient.

14. Whether any punishment/criminal/departmental awarded to the applicant in the post or/and

criminal case /departmental proceeding is pending against the applicant. Yes/No:

DECLARATION

I ……………………Son/Daughter of ……………………..solemnly declare that the particulars

furnished above are correct to the best of my knowledge and belief. I understand that in the event of

any of the particulars of information given herein being found false or incorrect, my candidature for

the selection is liable to be rejected or cancelled and in the event of any wrong statement/discrepancy

in the particulars being detected at any stage even after appointment my services are liable to be

terminated without any notice.

Place: Signature of the applicant

Date:

List of Enclosures:

ANNEXURE - I

UNDERTAKING

(FOR THE POST OF )

(Applicable in respect of employees who have retired/ resigned from Government / PSU /

Autonomous Body / Statutory Body / Local Body / Corporations etc.)

1. I certify that all statements made in this application are true, complete and correct to

the best of my knowledge and belief.

2. I certify that I am eligible for the post applied for vis-à-vis the qualifications and

experience prescribed for the said post.

3. I certify that no prosecution for criminal charge is pending against me in any court of

law.

4. I certify that no vigilance /disciplinary case was pending against me in the Ministry /

Department / Organization at the time of my retirement / resignation.

Note: Please enclose copy of Pension Payment Order (if applicable) and Order notifying

your discharge from service on retirement / resignation.

PLACE:

DATE:

SIGNATURE OF CANDIDATE _______________________

NAME OF CANDIDATE ______________________________

ANNEXURE - II

UNDERTAKING

(FOR THE POST OF )

(Applicable in respect of employees serving in private sector organization / presently not

working)

1. I certify that all statements made in this application are true, complete and correct to

the best of my knowledge and belief.

2. I certify that I am eligible for the post applied for vis-à-vis the qualifications and

experience prescribed for the said post.

3. I certify that no prosecution for criminal charge is pending against me in any court of

law.

4. I certify that no punitive action was taken against me for any misconduct during my

present / previous employment in private sector organization.

Note: Please enclose copy of last relieving Order / Certificate from private sector

PLACE:

DATE:

SIGNATURE OF CANDIDATE _______________________

NAME OF CANDIDATE ______________________________