FOR OFFICE USE

NMDC LIMITED
(A Govt. of India Enterprise)

Application for the Post of ___________________________________

Complex / Project for which applied _________________________________

Photo
Employment Notification No. ________________________________

Trade: Discipline :

Grade :

1 Name (IN BLOCK LETTERS)

2 Father's / Husband's Name
4 Gender

5 Date of Birth (dd/mm/yyyy)

6 Marital status

7 Religion
8 Nationality
9 Present Address (Mailing Address)

Village Tehsil District

State Pin code

Permanent Address:

Village Tehsil District

State Pin code

Phone No. STD code

Phone No. (with STD Code) / E-mail
10 ID (Interview call letters will be sent Mobile No.
through e-mail also)
E-mail ID @
UR SC ST OBC (Non EWS
Category (Please tick a) Enclose copy of Creamy Layer)
11 certificate in case of SC/ST/OBC (Non Creamy
Layer)

Whether the candidate is Physically

12 Yes: No:
Challenged? (Please tick a)
OH (OL) HH VH (LV) Disability: ____________%age
If yes, nature of Handicap &
13
percentage of disability
 Whether the candidate is an Ex-
14 Serviceman? (Please tick a) Yes: No:

Whether involved in any criminal

15 case/law suit at any time? (Please tick Yes: No:
a)
(a) Amount (b) Bank Journal Number
16 Details of Application fees paid
(d) Whether Original receipt enclosed
(c ) Receipt Number Yes/No
17
Educational Qualifications:

Name of Course/ Name of Board/ Month & Year Subject / Specialization Duration of Division /
Degree or Exam Institution/ University of Passing Course % of
Marks

18 (For Blaster Only)

Details of Post Qualification Experience (Use additional sheet if required)

Period (Exact dates to be

given) Scale of Pay &
Basic Pay (in case
Name of the Total Period Nature of Duties of Govt./PSU
Position/Designation Reason for
organization (Full with the area of work (Year & (maximum 500 employee) /CTC
Leaving
name with address) months) words) per annum (in case
From To of Pvt. Company
employee)

I certify, that the information furnished above is true, complete and correct to the best of my knowledge & belief. In the event of any
information being found false or in correct, my candidature may be cancelled and my appointment if made, shall stand terminated
without any notice and compensation

Place:
Date: Signature of Applicant

19 Sl No. Certificates Date of Issue

Reference No. of
the Certificate
1 Proof of Date of Birth/Name i.e. 10th Certificate
2 Certificates in respect of prescribed Qualification
 3 Marksheet of prescribed Qualification
4 Experience Certificates(as applicable only in case of para medical staff)

5 Caste Certificate (if applicable) / Non-creamy layer certificate for OBC

6 Any other
Note: Candidates are required to super scribe on the envelope (i) Employment Notification nos (ii) name of the post & trade applied
(iii) Complex/Project for which applied (iv) Mode of application -OFFLINE