THE ODISHA SCH. CASTE & SCH.

TRIBE DEVELOPMENT
FINANCE CO-OPERATIVE CORPORATION LIMITED
(A Govt. of Odisha Enterprise)
Lewis Road, Bhubaneswar-751014
: 0674-2431798 FAX: 0674-2432107 eMail: osfdc.odisha@gmail.com

Affix your recent

colored passport size
APPLICATION FORM photograph

1. Name in full :……….…………………………………………………..

(in Capital Letters)

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

3. Date of Birth (DD/MM/YYYY) :……….………………………….……………………….

4. Age as on 30.12.2019 : Years……………Months………….Days…………..

5. Caste (SC/ST/SEBC/OBC/GENERAL):

6. Sex (Male/Female) :…………...………………………..…………………….

7. Marital Status (Married/Single):……….………………………………………………….

8. Permanent Address :
…………………………………………………………………………………………………….

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

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9. Correspondence Address :
…………………………………………………………………………………………………….

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

..………………………….……………………………………………………………………….
10. Contact No. : Telephone:....………………………….………………

Mobile:…………………………………………….……
(Contd…..P/2)
[2]
11. e-Mail ID :…....………………………….………………………….

12. Educational / Professional Qualifications:

Sl Name of the Examination Year of Board / % of Division

No Passing College / Marks
University
1 High School / 10th / Equivalent

2 Intermediate / 12th / Equivalent

3 Graduation / Degree

4 Post Graduation

5 Professional Qualifications

6 Any other

13. Details of Employment (Start from the current experience):

Employer Post Period Salary Nature of

held From To Total Drawn Duties
(Date) (Date) Period
(in Months)

14. Briefly describe your job profile in the current organization:

(Please enclose additional sheets if required)

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

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

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

…………………………………………………………………………………………………….
(Contd…..P/3)
[3]

15. Why you should be considered for the position applied:

 (A brief write up may be given)

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

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

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

16. Names and address of two responsible persons (not relatives) who know about
the work, conduct etc. of the applicant well and one of whom must be the
present employer, in case the applicant is already in service.

Name and Address of Two Referees

Name : Name :
Address: Address:

Phone: Phone:
eMail: eMail:

17. List of enclosures :

1. ……………………………………… 2. …………………………………………….

3. ……………………………………… 4. …………………………………………….

5. ……………………………………… 6. …………………………………………….

7. ……………………………………… 8. …………………………………………….

9. ……………………………………… 10. …………………………………………….

DECLARATION BY THE CANDIDATE

I, ……………………………………………………………. hereby declare that the statements

made in the application are true, complete and correct to the best of my knowledge
and belief and in the event of any of the information being found false or incorrect or
any ineligibility being detected before or after the selection, my candidature is liable
to be cancelled and action taken against me.

Place: Candidate’s Signature :

Date: Full name :