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VIGNYAN INDUSTRIES LIMITED

(A Subsidiary of BEML LIMITED)


P.B. No, 4, B.H.Road, TARIKERE - 577228, Karnataka, India
Ph: 222357, 222252 & 222313. E-mail:vil@beml.co.in/ vkp.vil@beml.co.in
APPLIA!I"# $"%&
A've()i*emen) #o. +++++++++.
Po*) Applie' $o( +++++++++++.
In case of working in Govt/Quasi-Govt Organizations/ PSU, whether applied through proper channel
!es "o "ot applica#le
If !es, Please attach a cop$ of the forwarding letter of the e%plo$er or "O& to #e produced at the ti%e of Interview
'
#ame o, )he an'i'a)e
(in )lock *etters+
,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,
(-irst "a%e+ (.iddle "a%e+ (*ast "a%e+
/
-en'e( .please tick+

.ale -e%ale
0 $a)he(/* #ame Shri1
2
omm0nica)ion A''(e**
3ouse1"o 44411444444441 Street "o44444444444441
5illage44444444444444 6aluk444444444444444
7istrict1444444444444State44444444444441111111111111111
Pin &ode4444144 6elephone (office+4144444(ho%e+4444441
.o#ile44444441444 e%ail4444444411444444444411
8
1a)e o, 2i()h - 4414/44114/444411 9 A3e as on ,,,,,,,,,,,, 414!rs441144.onths44114117a$s
77 .. !!!!
: a4 #a)ionali)5 .b5 bi()h/ 'omicile4 : #+ %eli3ion :
;
a)e3o(5 .please tick4
S&/S6/O)& categor$ need to enclose
the caste certificate issued #$ the
&o%petent <uthorit$ as per Govt1 of
India notification/guidelines1

G=" O)& S& S6
.ention Su# &aste (if applica#le+44444444411
>
A(e 5o0 a Pe(*on 6i)h
1i*abili)ie* .P6147
If $es, %ention (53/O3/33+ and
enclose a cop$ of the supporting
docu%ent fro% the co%petent authorit$1
!es "o
If !es, %ention (53/O3/33+44449 Percentage of disa#ilit$444
?1 App(en)ice*hip / P(ac)ical )(ainin3 (%ore than ' %onth period+ (furnish details #elow+
"a%e @ <ddress of Institution "ature of 6raining Period 7uration
-ro% 6o
41//-
Paste self attested
recent passport
size Photograph
-/-
'A1 89ALI$IA!I"# (Starting fro% *atest Bualification acBuired+
E:am o(
1e3(ee/
1iploma
#ame o, )he In*)i)0)ion /
9nive(*i)5
&o'e
.%e30la(/o((e*pon
'ence/Pa()-)ime
;ea(*
<)0'ie'
;ea( o,
pa**in3
= o, &a(k* &
la** / 1ivi*ion
o( E>0ivalen)
3(a'in3
<peciali?a)ion
.2(anch inca*e
o, En334
=.P*O!.="6 C=&OC7 ("eed to #e supported #$ relieving letter at the ti%e of Doining+
!o)al E:pe(ience .5(*4 : !o)al po*) >0ali,ica)ion E:p .5(*4:
11. 0((en) Emplo5men)
(a+ "a%e @ <ddress of &urrent =%plo$er
7esignation Period 7uration (in $rs+
-ro% 6o
,(#+1 &o%plete )reak-Up of Salar$ and Perks-
(please enclose latest %onth Salar$ Slip+
Scale of Pa$
)asic
7<
3C<
<n$ Other (please specif$+
(c+ Other <nnual )enefits (please specif$+
Ann0al ! .All Incl0*ive4:
'/. P(evio0* Emplo5men) (Starting fro% the latest+
"a%e of the =%plo$er 7esignation
Period 7uration
(in !ears+ -ro%
(dd/%%/$$$$+
6o
(dd/%%/$$$$
+

E )reak during e%plo$%ent (if an$+1 Period @ Ceasons
'01 If $ou selected, how soon would $ou #e a#le to Doin dut$
'21 Processing F-ee
77 "u%#er 7ate <%ount )ank )ranch
1ELA%A!I"#
I here#$ declare that the a#ove state%ents are true, co%plete to the #est of %$ knowledge and #elief1 In the event, the
infor%ation is found to #e false or incorrect, %$ candidature / appoint%ent %a$ #e considered ter%inated without an$
notice1 I also declare that I a% citizen of India #$ #irth / do%icile1
Place:
1a)e: .<i3na)0(e o, )he an'i'a)e4
-3-
2%IE$ 6%I!E 9P "# ;"9% 89ALI$IA!I"#, E@PE%IE#E A#1 E@PE%!I<E I# !AE %E<PE!IBE A%EA
C1. #ame
C2. $a)he(/* #ame
C3. 80ali,ica)ion
CD. P(o,e**ional 6o(k E:pe(ience
C5. ")he( in,o(ma)ion, i, an5

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