NATIONAL COUNCIL OF EDUCATIONAL RESEARCH AND TRAINING

Office of the - NCERT, Sri Aurobindo Marg, New Delhi-110016

Delhi
NCERT Recruitment Cell, All Region

Website:- www.ncert.nic.in Email:- hrncertnewdelhi@gmail.com

Form No.-………………
Session-2022-2023

Application Form

Post Applied For : Group- C Group-

Group C
Supervisor Group-D Surveyor Affix recent
passport size
photograph
1. Full Name : ___________________________________________________
Identity should
be certified by
2. Father’s Name : ___________________________________________________ an officer as
mentioned in
3. Permanent Address : ___________________________________________________ the
advertisement
with
___________________________________________________ designation/seal

___________________________________________________

4. Present Address : ___________________________________________________

___________________________________________________

___________________________________________________

5. Date of Birth : __________________ 6. Sex : Male Female

7. Religion : _____________________
__________________ 8. Nationality : ______________________

9. State : ________________________ 10. Category : SC ST OBC GEN PH

11. Ex-Serviceman :
Date of Joining Service : _________________________________

Date of Discharge from Service : _________________________________

12. E-mail ID : _________________________________

13. Telephone No. (With STD Code) : _________________________________

14. Mobile No. (If any) : _________________________________

15. Educational Qualification :

Qualification Board/University Percentage of Marks Year of Passing

16. Experience :

Name of the Organization Designation Nature of Duty Period Duration

17. If employed in Govt. Dept./FCI, whether applied through proper channel : Yes/No

Declaration : I hereby declare that all statements made in the application are true, complete and correct to the
best of my knowledge and belief. I also undertake that I have not submitted application for two different posts
advertised. The relevant clause is stated below for easy reference :- “Candidates can apply against any one post
only. Candidates applying for more than one post will not be considered and such applications will be rejected.’ I
understand that in the event of any information being found untrue/false/incorrect or I do not satisfy the eligibility
criteria, my candidature/appointment will be cancelled/terminated, without assigning any reasons thereof. I have
read the contents of the advertisement and agree to abide by the rules, regulations and procedures for appointment
to the post applied for.

Date :
(Signature of Applicant)
Place :
 IDENTITY CERTIFICATE

Affix Photograph

Seal of office & Signature of the

officer attesting this certificate
should appear on the
Photograph

This is certify that the details and photograph of Shri/Smt. ______________________________ S/o/D/o

___________________________________________________ and resident of (R/O)

_____________________________________________________________________________ who has applied

for the post of __________________________________________________ is verified and certified as correct

and genuine.

PERMANENT ADDRESS :
___________________________________________________________________________________________
___________________________________________________________________________________________
____________________________________________________

PRESENT ADDRESS :
___________________________________________________________________________________________
___________________________________________________________________________________________
____________________________________________________

Signature of the Candidate : ________________________________________

Signature of the Certifying Officer : ________________________________________

Name of Certifying Officer : ________________________________________

Phone No. of Certifying Officer : ________________________________________

Designation : ________________________________________
(Seal of Office)

[Note : Identity of the Candidate should be certified by an officer not below the rank of Tehsildar/Sub-Divisional
Officer of the candidate’s domicile place/native place, Principal of the school/college from where the candidate
has passed his Metric, Intermediate or Graduation/ Diploma along with name, designation and seal of office.]
 layXudksa dh lwph
List of Enclosures

;Fkksfpr vk;r esa lgh dk fpUg yxk,¡ layXu fd;k layXu ugha fd;k
Tick the appropriate box Enclosed Not enclosed

1) vk;q dk lk{; izek.ki= dk uke ¼gkbZ Ldwy izek.ki=] ikliksVZ bR;kfn½

1) Proof of Age – Name of Document (High School Certificate, Passport, Others)

2) 12 oha@fMIyksek vad rkfydk ,oa izek.ki=

2) XII Std./Diploma Mark Sheet and Certificate

3) Lukrd vad&rkfydk ¼d`i;k Li"V :i ls mYys[k djsa tSls ch-,-@ch-,llh- bR;kfn½

3) Graduation Mark-sheet (Please specify B.A./B.Sc. etc.)

xzstq,'ku vad lwph ¼d`i;k mYys[k djsa ch-,-@ch-,llh-@ch-Vsd@ch-dkWe@vU;½

Graduation Mark Sheet (Please specify B.A./B.Sc./B.Tech/B.Com. or Others)

igyk l=
First Semester

nwljk l= ;k igyk o"kZ

Second Semester or First Year

rhljk l=
Third Semester

pkSFkk l= ;k nwljk o’kZ

Fourth Semester or Second Year

Ikk¡pok l=
Fifth Semester

NBk l= ;k rhljk o"kZ

Sixth Semester or Third Year

lkrok¡ l=
Seventh Semester

vkBok¡ l= ;k pkSFkk o"kZ

Eight Semester or Fourth Year

ldy vad
Aggregate Marks

4) Lukrd fMxzh ¼d`i;k mYys[k djsa tSls ch-,-@ch-,llh@ch-Vsd@ch-dkWe@vU;½

4) Graduation Degree (Please specify B.A/B.Sc/B.Tech/B.Com or Others)

5) O;kolkf;d f'k{kk@iksLV xzstq,'ku izek.ki=

5) Professional Qualification/Post Graduation Certificate
6) nks@rhu pfj= izek.ki= tSlk ykxw gks

6) Two/Three Character Certificate As applicable

7) dEI;wVj n{krk dk izek.ki= ¼;fn dksbZ gks½

7) Certificate of Computer Proficiency (if any)

8) oÙkZeku fu;kstd ls vukifRr izek.ki=

8) No Objection Certificate from Present Employer

9) vuqHko izek.ki=
9) Experience Certificate

10) foeqfDr izek.ki=

10) Discharge Certificate

11) ckj dkmafly@esfMdy dkmafly esa iathdj.k

11) Registration with Bar Council/Medical Council

12) esfMdy Js.kh ls lacaf/kr izek.ki=

12) Certificate regarding Medical Category

13) vU; ;ksX;rk,¡ ¼d`i;k Li"V :i ls mYys[k djsa½

13) Other Qualification (Please specify)

14) ikB~;Øe laca/kh vU; xfrfof/k;ksa ls lacaf/kr izek.ki= ¼d`i;k Li"V :i ls mYys[k djsa½
14) Certificate regarding extra curricular activity (Please specify)

15) tkfr izek.ki= ¼ykxw gks rks½

15) Caste Certificate (If applicable)

fnukad % vH;FkhZ dk gLrk{kj

Date : Signature of candidate

vH;FkhZ dk ck;s vaxqBs dk fu”kku

Left Hand Thumbs Imp ration

DECLARATION TO BE SUBMITTED BY THE OTHER BACKWARD CLASSES CANDIDATES
SEEKING RESERVATION AS OBC

“I ____________________________________________________________________ Son/daughter
of Shri ____________________________________________________ Resident of village/town/city
_____________________ District ___________________ State
_______________________________________________. Hereby declare that I belong to the
____________________________________________ community which is recognized as a backward
class by the Government of India for the purpose of reservation in services as per orders contained in
Department of Personnel and Training Office Memorandum No. 36012/22/93-Estt. (SCT) dated
08.09.1993. It is also declared that I do not belong to persons/sections (Creamy Layer) mentioned in
column 3 of the Schedule to the above referred Office Memorandum dated 08.09.1993.”

Place :
Dated : (Signature of the candidate)

vU; fiNM+s oxZ ds :i esa vkj{k.k dh ekax djus okys vU; fiNM+s oxksZa ds mEehnokjksa
}kjk izLrqr dh tkus okyh ?kks"k.kk

^^eSa &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& iq=@iq=h Jh

&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& fuoklh
&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& xkao@dLck@'kgj
&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& ftyk &&&&&&&&&&&&&&&&&&&&&&&&&&&&&& jkT;
&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& ,rn~ }kjk ?kks"k.kk djrk@djrh gw¡ fd eSa
&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& tkfr ls lacaf/kr gw¡ ftls Hkkjr ljdkj }kjk dkfeZd ,oa
izf'k{k.k dk;kZy; Kkiu Øekad 36012@22@93&bZ,lVhVh¼,l lh Vh½ fnuakad 08-09-1993 esa lekfo"V vkns'kksa ds vuqlkj
lsokvksa esa vkj{k.k ds iz;kstu gsrq ,d fiNM+s oxZ ds :i esa ekU;rk nh xbZ gS] ;g Hkh ?kks"k.kk dh tkrh gS fd eSa mi;qZDr
lanfHkZr dk;kZy; Kkiu fnukad 08-09-1993 dh vuqlwph ds LraHk 3 esa mfYyf[kr O;fDr;ksa@[k.Mksg ¼fØeh ys;j½ ls
lacaf/kr ugha gw¡ A

LFkku %
fnukad % ¼mEehnokj ds gLrk{kj½

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