PROFORMA

Post Applied for:___________________________________

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PP

Photo

Name:
Date of Birth:
Date of retirement under Central/State Government rules
Educational Qualifications
Whether educational qualifications required for the post is satisfied. If any qualification has been
treated as equivalent to the one prescribed in the rules, state the authority for the same.
Qualification/Experience
required

Qualification/Experience possessed
by the Officer

Essential : (1) (2) (3)

Desirable : (1) (2) (3)
6.
7.

Please state clearly whether in the light of entires made by you above, you meet the requirements
of the post.
Details of Employment in choronological order. Enclose a separate sheet duly authenticated by
your signature if the space below insufficient.

Office/Instt./
Orgn.
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15.

Scale of pay Nature of duties

and basic pay performed
therein
Nature of present employment i.e. ad-hoc or temporary or Quasi-permanent or permanent.
In case the present employment is held on deputation/contract basis, please state :
a) The date of initial apointment
b) Period of appointment on depuation/contract.
c) Name of the parent office/organisation to which you belong.
Additional detials about your present employment. Please state whether working under :
(a) Central Government
(b) State Government
(c) Autonomus or Statutory Organisation
(d) Public Sector Undertakings
(e) Universities
(f) Recognised Research Institutions
Are you in revised scale of pay, if yes, give the date from which the revision took place and also
indicate the pre-revised scale
Total emoluments per month now drawn.
Additional information, if any, which you would like to mention in support of your suitability for
the post. Enclose a separate sheet if the space is insufficient.
Whether belongs to SC/ST/OBC
Remarks

Date:

Post held

From

To

Signature of the candidate

Address______________

It is certified that particulasrs furnished are correct and no disciplinary case is either pending or
contemplated against the officer and no penalty major or minor, was imposed on the officer during the
last 10 years and his integrity is beyond doubt.
Signature of the Head of Department (With Stamp)