KERALA ELECTRICAL & ALLIED ENGINEERING COMPANY LIMITED, KOCHI-36

Application No.
(for office use only)
Affix recent
Passport size
Colour Photograph
1. Post Applied for
2. Name of the candidate
(in Bloc letters)
!. "ex # $ale % &emale
'. a) Age ((ears completed)
as on )1%)1%2)1*
+. &ather,s Name
APP-.CA/.0N &01$A/ here
*. $arital "tatus # $arried % 2nmarried
3) 4ate of Birth 4 4 $ $ ((((
5. a) 4omicile "tate# $other /ongue#
3) Category (Put a ( ) tic mar in the appropriate Box
67N 0BC "C "/ P 8
(Non9creamy layer
:. Correspondence Address# Permanent Address#
Pin Code Pin Code
;. Contact /elephone Num3er # 79mail .4 #
$o3il Num3er #
1). 7ducational <ualification
Name of Name of = of $ars%
.nstitution 2ni>ersity Name of Course Class%4i>ision Nature of Course
11. 7xperience
1eason for
Name 0rganization Post Period "alary details relie>ing
12. Any other <ualifications
1!. 4 4 details 44 No. 4ate Rs. Name of 3an
. here3y declare that all the statement made in this application are true and complete to the 3est of my
no?ledge. .f at any stage of the selection process the a3o>e statements are found to 3e false or
incomplete@ . understand that my candidature ?ill stand cancelled.
4ate #AAAAAAAAAAAAA "ignature# AAAAAAAAAAAAAA