APPLICATION/BIO DATA FORM 1.

Post Applied for : Junior Assistant

Affix a passport size photo here.

2. Examination Centre : _________________________________ (Write the name of the Centre opted) Chennai Coimbatore Trichy Madurai Vijayawada Bangalore Trivandrum 3. PERSONAL DETAILS: i. Name of the Applicant : (in CAPITAL LETTERS)

ii. Sex ( the appropriate column) Male Female

iii. Marital Status: Married/Unmarried (Strike-out which is not applicable) iv. Name of Father/Husband (incase married):

v. Date of Birth : Fill in the format dd/mm/yyyy vi. Age as on 31.05.2011 Years vii. Address for Communication Months

State _______________________ Pin code: Phone No. _________________________ Email Id. ___________________________ viii. Category: ( the appropriate column) OBC SC ST Repatriate Others

ix. Nationality : _________________ x. Native Place :

xi. Languages known : Language Speak Read Write

xii. Academic / Educational /Technical Qualification: Qualification Year & Month Name of Institution / of Passing University / Board Percentage of marks/OGPA

xiii. Professional (Computer) Qualification: Name of the Degree/ Name of the Institution Diploma/others (specify) Year of passing

xiv. Experience : Name of the Institution From To Designation

xv. Details of Relatives working in Repco if any Emp.No. Name of Staff Designation Nature of Relationship

4.FEE REMITTANCE : Name of the BANK Demand Draft No. Amount Date of DD

5.DECLARATION:- I hereby declare that the information furnished in this application are true , complete and correct to the best of my knowledge and belief.

Signature of the Candidate