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    For Filing: Start Application Form)

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    Sachin SC
    This document is an application form for employment with the Employee's State Insurance Corporation. It requests information such as the applicant's name, date of birth, citizenship, contact details, educational qualifications, work experience, and a declaration signed by the applicant. The form instructs applicants to read guidelines carefully before filling it out and provides spaces for details like photo, thumb impression, and signature.

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    For Filing: Start Application Form)

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    Sachin SC
    13 views1 page
    This document is an application form for employment with the Employee's State Insurance Corporation. It requests information such as the applicant's name, date of birth, citizenship, contact details, educational qualifications, work experience, and a declaration signed by the applicant. The form instructs applicants to read guidelines carefully before filling it out and provides spaces for details like photo, thumb impression, and signature.

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    This document is an application form for employment with the Employee's State Insurance Corporation. It requests information such as the applicant's name, date of birth, citizenship, contact details, educational qualifications, work experience, and a declaration signed by the applicant. The form instructs applicants to read guidelines carefully before filling it out and provides spaces for details like photo, thumb impression, and signature.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    13 views1 page

    For Filing: Start Application Form)

    Uploaded by

    Sachin SC
    This document is an application form for employment with the Employee's State Insurance Corporation. It requests information such as the applicant's name, date of birth, citizenship, contact details, educational qualifications, work experience, and a declaration signed by the applicant. The form instructs applicants to read guidelines carefully before filling it out and provides spaces for details like photo, thumb impression, and signature.

    Copyright:

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    of 1

    EMOPTOYEE'S STATE INSURANCE CORPORAIION

    APPUCATTON _ FORM
    (Bead the gUidelines earefully, before you start filing up the Application Form)
    01. (a) Post Applied for -
    (b) STAIE for which applied
    (0nly one option to be given)
    02 Name in full (in Block letters)
    03. Father / Husband's Name Paste your

    (a) Amount of fee Rs. recent passport


    04.
    size photogaph
    (b) Name of the Issuing Bank
    attested by a
    (c) Denand Draft No. & Date Gr.-ttAt7 Gr.J'Btt/
    05. Date of Birth in Christian era Gaaetted Officer
    (In figures and in words)

    Age as on closing
    (date for receipt ofapplication) (Year) (Month) (Dav)

    06. fue you a citizen of India by Signature of the


    birth and / or domicile? candidate.
    (only in
    07. Permanent Address (in Block letters) running hand)
    with Pin Code Number
    (Mobile / Phone No.)

    08. Mailing Address (in Block letten) :

    with Pin Code Number


    (Mobile / Phone No.)

    09. Category you belong to


    Code ofcategory
    (Genl.-01, SC-02, ST-03, 0BC-04)

    10. Whether you are PH or Ex. Serviceman

    (PH-05, Ex. Serviceman-06)


    11. Sex (please make tick mark) :Male()/Femaleo
    12. Educational/Technical qualifications:-

    s, Percentage
    Qualifrcation University Eoard Subject studied Year of Passing Remarks
    No. of Ma,rks obtained

    Experience / particulars of previous and present employment:-

    S. Period of employment
    Name & full addressof Employer Designation lDuties of post Scale of Pay
    No.

    14. Details of other academic achievements, extra currieular activities, and professional achievements, if any.............,..
    15.

    2:..................
    4:..................,,,........

    DocLrationl
    I hereby declarc that the infotmation lurnished in the application are true, complete and correct to the best of nV knowledge and belieL l anfllly.vrare that in the event

    s.tion in lieu thereol


    Thumb Inpression of Candidate Signature of Candidate (on\y in mnninq hand).
    (lllandatory) (Mandatory)

    iiti
    I

    lirlL-.-J
    ; (Space for Left Thumb Impression (Space for Signature)
    i for Male Candidate 0r Right Thumb Impression for Female Candidate)
    I Phce,,
    I n"t",
    I

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