Application Form for the Post of CLERK on Temporary Basis

To,
The Chief Executive Officer,
Maharashtra Education Society,
1214-1215, Sadashiv Peth, Pune 411 030.

Reference : Advertisement in __________________________ Dated _________________

Sir,
With reference to above referred advertisement, I wish to apply for the post of Temporary basis
CLERK in Society’s School or College. My Bio-data is as given below.

BIO- DATA
(1) Full Name of the candidate (1) C_oXdmamMo g§nyU© Zmd
AmS>Zmd …-----------------------------

Surname
ñdV‹…Mo Zmd … --------------------------

First Name
_Ybo Zmd … ---------------------------

Middle Name
(2) Female/ Male (2) ór/ nwéf
(3) Date of Birth : __________________Age : _____
(3) OÝ_ {XZm§H$ … --------------- d` … df©o
(4) Permanant Address : (with Pin Code) (4) H$m`_Mm nÎmm … -------------------------
------------------------------------------------------------------- ----------------------------------
--------------------------------------------------------------- ----------------------------------
------------------------------Pin Code------------------- --------------Q>nmb gyMr H«$.> -----------

(5) Correspondance Address : (with Pin Code)
----------------------------------------------------------------
----------------------------------------------------------------
--------------------------Pin Code ------------------------
Tel. No. ----------------------------------------------------
Mobile No. ------------------------------------------------
E-mail address :
(5) nÌì`dhmamMm nÎmm …-----------------------
--------------------------------------
--- -----------------------------------
--------------Q>nmb gyMr H«$.> --------------
XyaÜdZr H«$. ---------------------------------------------------------
_mo~o mB©b (^«_U^mf) H«$. -----------------------

(6) Category :
S.C. / S.T./ V.J. (A)/ N.T.(B)/ N.T.(C)/ N.T.(D)/ O.B.C./ S.B.C./ Non-B.C. (OPEN)
(Tick the applicable category * Enclose the certificate of proper authority for reservation catagory candidates.)

(7) Whether physically handicapped (7) C_oXdma emar[aH$ÑîQ>çm An§J Amho H$m` ?
(greater than 40%)? if yes, attach details. (40% nojm OmñV An§JËd) Vnerb OmoS>mdm
.......2/-...
 .. 2 ..

(8) Educational Qualification : ________________ (8) e¡j{UH$ Ah©Vm … ------------------------

Examination / Board/ Special Year Marks Percentage

Degree University/ Institute Subject of passing Obtain out of or grade

B.Com.

M.Com.

English Typing

Marathi Typing

Computer knowledge

Tally

Other (if any)

(9) Work Experience if any (H$m_mMm nydm©Zw^d) :-

Name of the Institute Designation Period Reason/ s behind leaving

g§ñWoMo Zmd nX H$mbmdYr gmoS>Ê`mMo H$maU
From to
nmgyZ n`ªV

Information given above is true and correct to my knowledge and belief. (darb _m{hVr g§nyU©nUo gË` d AMyH$ Amho.)

Place ( ñWmZ) :________________________

Date ({XZm§H$):________________________ Signature of the applicant

(C_oXdmamMr ghr)

Note : Applicants need not attach any kind of Xerox copies (other than a xerox copy of cast certificate in case
of reservation catagory) to this form. At the time of interview, if called for, applicant must bring xerox copies
of the documents and Originals for verification. AOm©gmo~V amIrd g§dJm©Mo à_mUnÌ dJiVm AÝ` H$mJXnÌo OmoSy> Z`oV.
_wbmIVrbm ~mobmdë`mg gd© _yi à_mUnÌo d Ë`mMr àË`oH$s EH$ gË`àV gmXa H$amdr.

Processing Charges
Rs.200/- non refundable.