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Ministry of Human
RPsourcP Dewlopment
Oep"rtment: J,A JJOUR A ND EMPLOYMENT
A PPLICATION FOR NEW ENROLL M ENT
1
(' Marked Fields arc mandatory)

Applicant's Details
1
*Applicant 's Name ...A..~.\.....A.S..Y.1.H.f..<Z. ...M 0 A\ '1 Af9
*Applicant's Gender Male [~ r emale
*Mobi le Number .... 9..\ ..\.\J .J ..8.~..J )..........
* Father's Name ...... f:'J.Y..-.. A.B..B.B~ ....~ .<?..J:\J ~ A fJ1
*Dale Of Bi11h
Religion
.......&..Q~..... e~.~.r::?. ..............
...............1.~ .~;?.~.\
\.9.3.o
.
Caste .......B .~.\:)B-.A.... .C.'f0.Vs..Ll M)
Eye Sight ······························ ·················
Height -5 - 1 ()
···············································
Weight ··· ··· ··· ····· ··~ ··?,;.; ·.\~.S:.. .. .... .....
Recommended occupation .. ...... ..S.c:t.E. l-:JTI.$.T .......... .
Altemative occupation .........f..t 1••~ . ~ f:0 ..f:I .S.l 5T.. .......
Other Details
*Mail Id ...Xii/.N.P.t_ ~J.&P..S...5.....~J fv 1/ 'h?ct/_f • ( 0 °Vv1
'' Pan Number ....~ .....F.N.:X.PJ~l.. l\ b 8 3 ("\
'' Aadhar card Number ...:1.8:~l.~.J.!;-.1.~~ :s:.t k .......
*Qualification ........H.:..S. .-..S :....<;.................
Grade ...........5.:.7..·..f...;t...................
ln sti tution ......~J~.t~.<:D. .'3.N ..y..1:1...T.l.h.B.k _
Date of Registration
Prominent Identification Mark
Employment Exchange Name

Date: J.2,.}..~ .ft.fj ........... Signature Ii cant

Pl ace: .U..J,J..A.J.N,........ .

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 J)epartment: LABOUR AND EMPLOYMENT
APPLICATION FOR NEW ENROLLMENT

Addn•ss Details
• State J.:jA.l?.HB.t .f.t ..f.~ A f} F-S 1-1
'' District .....W.TI.'3.!.~J..........
• Sub-Div1s1on ······u::r.1:/1.1..~1....... .
• circle Office
Postal Address
;_;··,;·~~n~i·L.';-;;2.... Ata t3 H ~u, Av
..;>. ·'" ~· •• t~ • • • rr? J.. <~ll .~
(Y) 1}~'1
Temporary Address .<;(! .0. .l. J. J:--J. .q . -:. ~ .. &F.> Gu, fl R_ W ~I
\.Jl 7 Al t---J (M . f. )
S upporting Documents
I. ' Proof of Residence ~5"(,o o ~
2 Age proof certificate (Birth Certifi cate/ HSLC Admit Card/ School Certificate etc.)
3 *Educational Qualification Certificate (Mandatory)
4. Additional Qual ificati on Certificate etc.
5 Experience Certificate (if any)
6 Copy of Original I-Card issued by the competent authority
7 *Self-attested passport sized photograph
8 NOC from current employer (in case if employed)
9 Any Other Doc ument.

Date: ... {.2.~.J.. -::..h .9..{.0

Place: . .U.JJ..0J.. fY......... .

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