APPLICATION FORM 1. 2. 3. 4.

Application for the post of (see Note Below) Name in full (in block letter) Father/Husband Name Permanent address (with PIN code) :- Data Entry Operator / Stenographer Gd. III :::-

Affix your photo-graph here signed & attested

5.

Present Postal Address (with PIN code)

:-

6. 7.

Phone/Contact Ph. /Mob. No Date of Birth

:- ............................................................. :DD MM YYYY

8.

Age as on:- 01.01.2013

:-

Day

Month

Year

9.

Nationality

::Male Female

10. Sex

11. Marital Status 12. Category

::GEN

Male OBC

Female SC ST PH (HH)

(Attach Xerox copies of certificate in prescribed format duly attested in case of Sc, St, OBC, PH) 13. Educational QualificationName of the exam University/College/School Year of passing Class/ Division / Grade % of marks Subject taken

Matric 10+2 Graduation Professional Qualification Attach Xerox copies duly attested by Gazetted Officer. In case of private institution it is to be mentioned whether the course is recognized /affiliated by Government etc. 14. Particulars of present employment in any. 15. Experience (in any) (documents to be enclosed) SI.No Name of the Orgn. From To Designation Gross annual Nature of duties

16. Knowledge of Computers and MS Word/MS office / Excel :Y/N 17 (a) Centre opted for written test/interview (for Data Entry Operator Only) (___________________) (PUNE / KOLKATA / LUCKNOW / DELHI / CHENNAI / JALANDHAR / AHEMDABAD / SECUNDERABAD) (b) Centre opted for written test/interview (for Stenographer III Only) (__________) ( AHEMDABAD / SECUNDERABAD) 18. DECLARATION : I hereby declare that all statements made in this application are true, complete and correct to the best of my knowledge and belief. In the event of any information found false or incorrect or ineligibility being detected before or after the test and interview, my candidature will stand cancelled and my claims for the recruitment forfeited. Place:Date:-

Signature of Candidate