Position:

Affix Passport size Photograph

Name ( in block letters) : Gender (male/Female) : Fathers/Mothers Name : Address for communication :

Present Address (residential certificate issued by Tahasildar/Authorized Revenue official to be attached) :

Date of Birth/Age :

Category [General/SC/ST/OBC (SC/ST/OBC candidates need to enclose

a copy of relevant certificate as per Government of India notification/Guidelines] :

Person with Disabilities (PWD) status (certificate copy to be enclosed, if applicable): Qualification: Examination Board/University Year of passing % of marks Class/Divi sion

Application Fee Details : Amount (In Rs) DD No Date of Issue Bank Name Branch : : : : :

Declaration I do hereby declare that the particulars furnished above by me are correct to the best of my knowledge and belief in the event of any information being found to be false or incorrect my candidature/appointment may be cancelled / terminated without any notice.

Place: Date:

Signature of the applicant