Scribd Logo
Upload

Welcome to Scribd!

  • Iocl 1

    Uploaded by

    Smruti Ranjan Panigrahi
    11 views1 page
    This document contains an application format for candidates with disabilities applying for reserved posts. The format requests information such as the candidate's name, father/husband's name, address, date of birth, gender, category, type of disability, nationality, education qualifications, employment details, and a declaration that the information provided is true. It notes that candidates must write the post applied for on the envelope, submit a medical certificate pertaining to their disability, and (if applicable) submit a caste certificate.

    Original Description:

    Original Title

    IOCL-1

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    This document contains an application format for candidates with disabilities applying for reserved posts. The format requests information such as the candidate's name, father/husband's name, address, date of birth, gender, category, type of disability, nationality, education qualifications, employment details, and a declaration that the information provided is true. It notes that candidates must write the post applied for on the envelope, submit a medical certificate pertaining to their disability, and (if applicable) submit a caste certificate.

    Copyright:

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

    Iocl 1

    Uploaded by

    Smruti Ranjan Panigrahi
    This document contains an application format for candidates with disabilities applying for reserved posts. The format requests information such as the candidate's name, father/husband's name, address, date of birth, gender, category, type of disability, nationality, education qualifications, employment details, and a declaration that the information provided is true. It notes that candidates must write the post applied for on the envelope, submit a medical certificate pertaining to their disability, and (if applicable) submit a caste certificate.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 1

    APPLICATION FORMAT

    (To be filled by the candidates in his/her own handwriting in capital letters)


    Candidates to
    affix recent
    I hereby apply for the post of _________________________________________________ passport size
    Photograph
    reserved for person with disabilities (PWD) having disability of hunch-
    back or deformity of chest.
    NAME OF CANDIDATE
    1 (As recorded in the Matric/ Secondary School
    Certificate)
    FATHER’S/HUSBAND’S NAME
    2

    FULL POSTAL ADDRESS FOR


    3
    COMMUNICATION (With Pin code No.)

    DAY MONTH YEAR


    DATE OF BIRTH
    4

    AGE AS ON 01/4/2011
    ___________ YEARS __________ MONTHS

    5 SEX (Please tick) MALE FEMALE

    CATEGORY SC ST OBC GEN


    6
    (Please tick)

    HUNCH DEFORMITY
    7 TYPE OF DISABILITY (Please tick) BACK OF CHEST

    8 NATIONALITY

    9 STATE OF DOMICILE

    10 RELIGION
    CONTACT NO. (Telephone (with STD code/
    11
    Mobile)
    12 E-MAIL ID
    TH
    13. EDUCATIONAL QUALIFICATION (MATRIC/CLASS X ONWARDS):

    Qualification : Duration Month and Year


    % of Marks
    (Academic, Technical, Professional & Name of Board / Institute Of Course
    Joining Passing Obtained
    computer related, if any) (in years)
    course course

    14. DETAILS OF EMPLOYMENT, IF ANY


    Name & Address of Period of service Salary / Reason for
    Post held Nature of job
    Employer From To month leaving

    I hereby declare that I have read all the conditions mentioned in the advertisement and I fulfill the same. The statements made in this application are true,
    complete and correct to the best of my knowledge and belief. I understand that in the event of any particular or information given herein being found false or
    incorrect, my candidature is liable to be cancelled and in the event of any mis-statement/discrepancy in the particulars being detected after my appointment, my
    service is liable to be terminated without any notice to me.

    Date: ……………. Place: …………………. Signature………………………

    Note:
    1. Candidates must write name of the post applied for on the top of envelope containing application form.
    2. Candidate must submit a Medical Certificate issued by a Medical Board attached to the Special Employment Exchange/Vocational Rehabilitation
    Centre for PWD or Head of concerned Department of a Government Civil Hospital pertaining to disability claimed.
    3. In case of SC/ST/OBC candidate must submit a valid certificate of proof of caste issued by Competent Authority.
    4. No other certificate to be attached

    You might also like