Cabinet Secretariat: A) Length of Service: B) Date of Joining: C) Date of Discahrge

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CABINET SECRETARIAT

Note: Please fill in the form in English Capital letters. Advt. No. -06/13 Post applied for (Tick against relevant post)

Lower Division Clerk Assistant 1. Name :

2. Address for Correspondence : PIN STATE 3. Contact No. :

4. Fathers Name

5. Date of Birth

Date

Month

Year

Place

6. Age as on Closing Date

Years

Months

Days

7. Code for Category

8. If ex-serviceman, please indicate:a) Length of Service b) Date of joining c) Date of Discahrge 9. Sex 10. Nationality 11. Marital Status : : : : 10. Religion : : : Years Months Days

12. Educational Qualifications:Exam/ Degree passed

University/ Board

Year of passing

Duration of the Degree/ Diploma

Subjects Studied

Aggregate Marks with Percentage

13. Whether Employed or not

14. If yes, Details of Employment in the Chronological Order:Office/ Institute/ Organistaion Post Held Ad-hoc/ Regular /Tem/ Pmt. Exact date to be given From To Scale of Pay Nature of Duties

15. Computer Knowledge

16. Typewriting Speed 17. Language Known

: : Language Read Write Speak

18. Examination Centre

Delhi Mumbai Kolkata Chennai Lucknow Shillong

(Note: The department reserves the right of final allotment of examination centre) DECLARATION
I hereby declare that a) I fulfill the eligibility for the post applied for; b) I have not submitted any other application in response to the same advertisement. In the event of information or part there of being found incorrect at any stage, my candidature/appointment is liable to be cancelled/terminated without any notice to me and action can be taken against me. Place: Date: Signature of the applicant

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