3/5/2015

Registration Slip
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FOOD CORPORATION OF INDIA
ADVERTISEMENT NO. 3/ 2015 FCI CATEGORY - III
ZONE-WISE RECRUITMENT for
Junior Engineer (JE) (Civil Engineering / Electrical Engineering / Mechanical Engineering),
Assistant Grade-II (Hindi), Typist (Hindi) and Assistant Grade-III (General / Accounts / Technical / Depot)

Registered Application Form

Application Form for the Post of : Assistant Grade III (Accounts) ( G )

SOUTH ZONE

Registration Number : 27220038639

1. Candidate's Name :

NANJAPPA M
(Name as recorded in the Matriculation / Secondary Examination Certificate)

2. (a) Father's Name :

22.Photo

MARAPPA

(b) Mother's Name :

SUBBAMMA

3. Gender :

MALE

4. Date of Birth :
(As recorded in the Matriculation /
Secondary Examination Certificate.)

06/07/1986

6. Category :

OBC

5. Age :

28 Year(s), 5 Month(s), 26 Day(s)

as on (01.01.2015)
23.Signature

7. Whether Domiciled in the Kashmir Division in the State of Jammu and

Kashmir during the period 01-01-1980 to 31-12-1989:
8. Whether Ex-Servicemen / Availed the benefits of Ex-Servicemen:

NO

NO

9. Whether Person with Disabilities(PWD)/ Physically Handicapped(PH): NO

10. Whether Departmental (FCI) Employee: NO

11. Whether belonging to Minority Community: NO
12. Nationality : indian
13. Zone Applied For :

SOUTH

14. Name of the Written Test Center:

Bangalore

15. Post Applied For :

Assistant Grade III (Accounts) ( G )

16.Educational Qualification
(a) Name of Academic/
Professional Degree/ Diploma
(which makes you eligible):

(b) Name of the University /

Board:
(c) Year of Passing
(d) Duration
Programme :

of Course

(e) Percentage of Marks :

Bachelor of Commerce from a recognized University

Do you have :

YES

bangalore
(Whether Recognized University/ an Institution approved by AICTE or Board) : YES
2009

Proficiency in use of Computers

(Year)

36 (in Months)
65.42 %
(Marks up to 2 decimal points in aggregate of all years/ semesters (In case of CGPA / OGPA / Letter Grades, it is
equivalent percentage(%).

(f) Remarks if any :

17. Whether completed :

YES

18 (a). Email Id :

nanjappambabu65@gmail.com

(b). Confirm Email id:

19. Mobile Number :

nanjappambabu65@gmail.com
7411303805

https://fcijobsportal.com/AGIII2014/pages/RegSlip.aspx

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3/5/2015

Registration Slip

20. Experience :

YES - Total Experience : 31 ( in Months )

Details of Work Experience (starting from latest employment)

Name and
Address of
the
Employer(s)

sw amy v iv
ekananda r
ural pu coll
ege

Type of
Designation
Organisation

Nature Of
Duties

(Cent.Gov t./
State Gov t./
Cent.Gov t. PSU
/
State Gov t.
PSU/Others)
others

Period of Service

Length of
service
(in Months)

From

lecturer

teaching

To

Basic Scale of
Pay & Total
Emoluments

Type of Scale
(IDA/ CDA.If others,
equiv alent scale in
IDA/ CDA)

(per Month)

(DD/MM/YYYY)

(DD/MM/YYYY)

01/06/2012

31/01/2015

31

200000

Remarks
(if any)

consolidate

21. Communication Address :

(a). Address Line 1:

SHIVANAPURA V , CHIKKATIRUPATI POST

(6). Address Line 2:

HOSAKOTE TQ,

(c). City:

BANGALORE

(d). District:

BANGALORE RURAL

(e). Pin Code:

563130

(f). State:

Karnataka

24. Whether FEE Paid :

YES - Bank Reference Number : CP15891668 , Deposit Date : 05 Mar 2015

Amount {Excluding bank charges but including service tax of Rs. 39/-. Service Tax Code (Registration Number)
AAACF0365NST099} : 350 (in Rs.)

25. Declaration :
i. I have not submitted any other application for this examination. I am aware that if I contravene this rule, my application will be rejected summarily by
FCI.
ii. I have read the provisions in the Advertisement carefully and hereby undertake to abide by them.
iii. I further declare that I fulfill all the conditions of eligibility regarding age limits, educational qualifications, experience etc. prescribed for the post applied
for.
iv. I also declare that I do not stand debarred by FCI as on date and have never been convicted by any court of law. I also declare that no charge sheet is
pending against me in any court of law. Further declare that I have never been dismissed or compulsorily retired from the service of the Corporation or
from a Department of a State or the Central Government or from any Public Sector Undertaking or my service been terminated during probation.
v. For Candidate belonging to OBC I declare that I belong to the community, which is recognized as backward class by the Govt. of India for the purpose of reservation in services as per
order contained in Deptt. of Personnel and Training Office Memorandum No. 36012/ 22/ 93-Estt.(SCT) dated 8.9.1993. I also declare that I do not
belong to the person / sections (creamy layer) mentioned in column 3 of the schedule of the OM mentioned above and modified vide Govt. of India
DOPT OMs mentioned in the Notice. I further declare that I am in possession of OBC Certificate in the prescribed format given in the Notice of the
Advertisement.
vi. I hereby declare that there is no Vigilance / Disciplinary case pending against me. I am in possession of No Objection Certificate from my employer
which shall be required to be sent along with other essential enclosures in case of my shortlisting on the basis of the Written Test / Skill test at the
designated Address which shall be informed / notified through the designated website (www.fcijobsportal.com)
vii. I hereby declare that self-certified copies of relevant certificates / documents are in my possession. In case, self-certified copies of the relevant
certificates / documents are not provided by me along with the Registered Online Application Form Printout, if called for, my candidature will be
cancelled without any notice.
I hereby declare that all the information given/ statements made by me in the application are true, complete and correct to the best of my
knowledge and belief and nothing has been concealed or suppressed. In the event of any information being found false or incorrect or is not in
conformity with the eligibility criteria mentioned in the advertisement at any point of time my candidature / appointment may be cancelled / terminated
without any notice and / or I shall be liable for any other action under the extant rules.
Date: 05 Mar 2015
Place:

Signature:
Candidate's Name (in Capital letters):

(Please Print the form for Further Reference)

https://fcijobsportal.com/AGIII2014/pages/RegSlip.aspx

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