Application Format

1. Post applied for :

2. Name of Candidate (In Capital Letter) : Photo

(i) In English ..........................................

(ii) In Hindi ............................................

3. Father's/Husband's Name :

4. Date of Birth :

5. Sex :

6. A) Reservation Category (SC/ST/BC-I/BC-II/GEN) :

B) Local Residential Certificate of Chatra Distt :

7. Date of appointment to the present service :

8. Permanent Address :

9. Address for Correspondence :

10. Mobile No. :

11. Detail of Bank Draft :

Name of Bank Date of Issue Draft No Amount

12. Details of educational qualification

Result
Details of Year of
Institute/University/Board Main Subject Total Obtained % of
Exam Passing
Marks Marks Marks
Matric

Inter

Graduation

Post
Graduation
Computer

13. Details of Experience :

Position Held Period

(Whether on Pay Details of Level of
Name of
permanent/ Scale/Monthly Total Period Work Computer
Organization From To
regular/adhoc Emolument (Y/M/D) Experience Knowledge
basis

I hereby declare that the information furnished above is complete and true to the best of my knowledge and
belief.

Date :
Place :
Signature of the Candidate :