APPLICATION FORM

Date of Joining: 10 September, 2019

1. Data Entry Operator

Name of the Post Applied for: …………………………………………………….
Paste your recent
2. Full Name of the Candidate: ……………………………………………………… passport size
(In Capital) photograph
………………………………………………………………................

3. Date of Birth:
Day Month Year

4. Gender: ………………………………………………………………………………

5. Marital Status: ……………………………………..

6. Father’s/Husband’s Name: ……………………………………………………………………………

7. Mailing Address (in block letters): …………………………………………………………………….

…………………………………………………………………………………………………………..

…………………………………………………………………….. Pin Code: ……………………….

Tel. No. : ………………………………………………Mobile: ……………………………................

Email ID: ……………………………………………………………………………................

8. Nationality: ……………………………………..

10. Community (please tick  ) SC ST OBC GENERAL

11. All Educational/other professional Qualifications/Training Courses etc/Degree Examination

onwards:

Qualification Subject Board/College/University Year of Passing Percentage

 Details of Pervious Company Information

Company Name: …………………………………….

Position: ……………………………………………...

Address………………………………………....................

……………………………………………………………...

……………………………………………………………...

Email Id: ……………………………………………………

Website: ……………………………………………………..

I hereby declare that all the statements made in the application are true and complete to the best of my
knowledge and belief. I understand that action can be taken against me by the Commission, if I am declared
by them to be guilty of any type of misconduct mentioned herein. I have informed my Head Office/Dep’t, in
writing that I am applying for this selection.

Date:-…………………………. Signature of candidate

Note: - kindly attach identity proof and one photograph (Aadhaar Card/Driving Licence/Voter Id Card)

Regd. Office: 2nd Floor, S.M.S Complex, Above Bhagwan Das Cycle, Motijheel, Muzaffarpur-842001
Phone: +91-7280017831, Mail: support@picasowebsolutions.com, http://www.picasowebsolutions.com