DR. B.B.A.

GOVERNMENT POLYTECHNIC, KARAD (SILVASSA)

APPLICATION FOR THE POST OF ____________________________________

_________________________________________________________________________________
(Application should be Computerised type in Separate paper)

Paste recent
Passport size
Photograph
duly self
Attested

[1] Applicant’s Full Name (in Block Letter) : ______________________________________

[2] Father’s Full Name (in Block Letter) : ______________________________________

[3] Residential Address with Mobile No. : ______________________________________

______________________________________
______________________________________

[4] Date of Birth (DD/ MM/ YYYY) : ______________________________________

[5] Gender : ______________________________________

[6] Religion : ______________________________________

[7] Whether SC/ST/OBC/PH : ______________________________________

[8] Domicile (Yes/No) : DNH/ DAMAN/ DIU/ OTHER

(√ as appropriate)
[9] Educational Qualification
Sr. No. Board/ University Year of Passing Percentage
 [10] Experience, if any
Name of Designation Nature of Period of Service
Organisation Duty From To

[11] Declaration:

I, declare that I fulfill all the conditions of eligibility regarding Date of birth,
Education Qualification, Experience etc. for the post of ______________________________
to be filled-up in Dr. B.B.A. Government Polytechnic, Karad (Silvassa) on Short term
contract basis.

I, declare that all statements made in this application form are true, complete and
correct to the best of my knowledge and belief. I understand that in the event of any
information being found suppressed/ false or incorrect or ineligibility being detected before or
after the examination, my candidature/ appointment is liable to be cancelled.

(Signature of Candidate)
* Unsigned application will be rejected
Dated: /04/2023
Place:

* Following documents/ certificates are to be enclosed with application.

[01] SSC Marksheet.
[02] HSC Marksheet.
[03] School Leaving Certificate/ Birth Certificate.
[04] B.E/ B.Tech. All Marksheets.
[05] B.E/ B.Tech. Degree Certificate.
[06] M.E/ M.Tech. All Marksheets.
[07] M.E/ M.Tech. Degree Certificate.
[08] Ph.D. Degree Certificate.
[09] SC/ST/OBC/PH Certificate
[10] Experience Certificate.
[11] Any other relevant certificate.