Affix recent

passport size
1. Post applied for:.. colour
photograph
2. Name of the candidate: .....
(in BLOCK LETTERS)
3. Fathers Name: .....

4. Date of birth : 5. Age as on 01.01.2017 _____Years_____Months_____Days

6. Gender: 7. Nationality: .....

8. Marital Status: .... 9. Religion: ....

10. Category (GENERAL/OBC/SC/ST/PWD): ....

Enclose certificate in the prescribed format available on the website
If PWD, indicate whether VH/ HH / OH and extent of disability in percentage ....

11. Address:
PERMANENT CORRESPONDENCE

City: City:
State: State:
Pin Code: Pin Code:
Mobile No Mobile No
Mail ID (In Capital Letters):

12. Please specify the following details (if applicable)

a) Worked in (Army/Navy/Airforce) : ..........
b) Date of joining Defence Service : ..
c) Date of Discharge from Defence Service : ..
d) Character on discharge : ..
e) Service No.. Rank ...
13. Educational Qualification:
Educational Institution/College Name & Branch of Class Year of
Qualification Place /University Study Secured Passing

SSLC ---

PUC/Diploma

Degree

Page 1 of 3
14. POST QUALIFICATION WORK EXPERIENCE as on 01.01.2017 (if any), beginning with the current job:
Govt / Tenure of service
Semi Govt /
Name of the No of CTC (in
Public Sector From To Designation
organization Years & lakhs)
/ Private (DD/MM/YY) (DD/MM/YY)
Months
Sector

Total No.
of years
&
months
PLEASE ATTACH A SEPARATE SHEET GIVING A BRIEF ABOUT YOUR DUTIES & RESPONSIBILITIES IN ALL YOUR
JOBS

15. Please give particulars of your relative/s employed in BEL, if any:

Name Relationship Designation Department Unit

16. If you have appeared for any previous selection for appointment in BEL, please furnish details of
the same: ...

17. Application fee details (Exempted for SC/ST & PWD)

SBI Collect Reference No./ Journal No. Amount Date

Rs. ..

UNDERTAKING

I, affirm that the information given above is true and correct. I further undertake that if at any
stage, it is discovered that any attempt has been made by me to willfully conceal or misrepresent
the facts stated above, my candidature may summarily be rejected or my employment terminated.

Date:
Place: SIGNATURE OF THE CANDIDATE
Page 2 of 3
Tick the photocopies of the documents enclosed :
TICK THE
DOCUMENTS
BOX
SSLC/Matriculation Certificate (as proof of date of birth)
Discharge Book
All Semester wise/year wise marks cards of Diploma and / Or Graduation marks cards
Diploma and / Or Graduation Certificate
Caste / Disability certificate in case of SC / ST / PWD (if applicable, strictly in the
prescribed formats, which are available on the BEL website. OBC certificate should be
dated on or after 01.01.2016.)
Bank Challan (Original Depositors Copy) or Online Payment Receipt (if applicable)
No Objection Certificate (if applicable)
Experience Certificates from previous employers / Appointment letter in case of present
employer.

Page 3 of 3