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Self attested latest colored pp size photograph

APPLICATION FORM - CUM - BIODATA 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Adv. No. , Date & Name of News paper Employment Exchange Registration Card No. Post Applied for Name of Applicant Fathers/Husbands Name Sex(Male/Female) Marital Status Date of Birth Age as on 31/03/2013 Caste Category (Gen/SC/ST/PH/ Ex-SM/EX-KV) Nationality Religion Domicile Address Correspondence Permanent

Valid up to

11. 12. 13. 14.

Landline Telephone No. Mobile No. if any Contact Email ID 15. 16. 17. Language Known Hobbies Extra Co-Curricular Activities Competency to taught in Hindi & English both(Yes or No)

Cont.2/-(PTO)

-Page 218. Educational/Academic Qualification SI Exam. Passed Year Board/Inst./University Subjects Percentage

19. Professional Qualification(if any) SI Name of Course/Qualification

Duration

Name of Institute

Any other Information

20. Experience (if any) SI. Name of Institute/Office

Place

Designation

Service From To

Total period of Experience

21. Any other Qualification not covered under above(if any):.. .. 22. Computer Literacy/Software Proficiency: . 23.Current Status:-.

DECLARATION
I hereby declare that all the statements made in this application are true , complete and correct to the best of my knowledge and belief. Place:-.. Date:-. Signature of Applicant. Name:- Encl:-Attested photocopies of all Necessary certificates Mention no. of enclosure:...

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