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Hadoti Kshetriya Gramin Bank

Recruitment Project-2010
Application Format

(Fill all columns in legible capital letters in his/her own handwriting and use 8.27” x 11.69” size paper – A4 size)

Information in first five columns viz. Post, Name, Father’s Name, Address for
communication and Permanent address must be filled in ENGLISH ONLY

For Officers (Post Code-1) For Clerk-cum-Cashier (Post Code-2)

Paste your recent
` passport size
Hadoti Kshetriya Gramin Bank Hadoti Kshetriya Gramin Bank photograph and
sign it across.
Recruitment Projcet-2010 Recruitment Projcet-2010 Please retain
Post Box No. 8597 Post Box No. 9707 with you three
Kandivali (East), Borivali (East), copies of the
same photo for
MUMBAI-400101 MUMBAI-400066 subsequent use

Dear Sir,

With reference to Hadoti Kshetriya Gramin Bank Advertisement, I submit my application in

the prescribed format :-

1. A) Post applied __________________________________Code No. ____________

B) Additional Post applied _________________________ Code No. ____________

Have you sent separate application with requisite fees and postage for other post
also :

2. FULL NAME IN BLOCK LETTERS :

(Leave one space blank between two parts of your name)

3. FATHER’S / HUSBAND’S NAME IN BLOCK LETTERS

(Leave one space blank between two parts of your name)

4. ADDRESS FOR COMMUNICATION (In Block letters)

5. PERMANENT ADDRESS (In Block letters)

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6. Telephone No. with STD Code :

Cell No :

E-mail ID :

7. Centre for Written Examination :

8. Gender (Please indicate by putting √ in the appropriate BOX)

Male Female

9. Category to which you belong (Please indicate by putting √ in the appropriate

BOX)

SC ST OBC GENERAL

(Please attach attested photostat copy of Caste Certificiate of SC/ST/OBC as applicable)

a. Religion ________________Sub-caste ___________

b. Name of the State/UT to which you belong : _______
c. If Person with Disability
(Please indicate by putting √ in the appropriate BOX)

Orthopaedically Hearing Impaired Visually

Handicapped (OH) (HI) Handicappted
(VH)

Percentage of Disability __________________

(Please attach attested photostat copy of medical certificate issued by
Comptent Authority)

d. Are you eligible and intend to use the Service of Scribe ?

(Please indicate by putting √ in the appropriate BOX)

Yes No

e. Do you belong to Religious Minority :

Yes No

10. Are you an Ex-serviceman ?

Yes No

If yes, specify the following

i) Date of Discharge : ________________

ii) Rank at present/last held : ________________
a) Acting as : ________________ w.e.f. ________
b) Substantive : ________________ w.e.f. ________
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11. Are you divorced / judicially separated ?

Yes No

12. Are you a candidate who had originally been domiciled in Kashmir Division of the
State of J & K duirng the period of 01-01-1980 to 31-12-89

Yes No

13. (a) Date of birth (As per School Leaving Certificate SSC/SSLC)

Date Month Year

(b) Age as on 01-01-2010 ___________Years _________Months

(c) Relaxation in Age (if claimed) : No. of Years ______under Category _____

14. Nationality : _____________________

15. Details of Application Fees and Postage Charges :

Name & Address Name & address Demand Draft

Amount in
of Issuing Bank / of Drawee Bank / Date of issue / Bankers
Rs.
Branch Branch Cheque No.

(Application Fee should be sent in the form of Demand Draft in favour of “HKGB
Recruitment Officers Project 2010” or “HKGB Recruitment Clerical Project 2010” as
the case may be, paybable at Kota only. Fees for General and OBC candidates is
Rs. 300/- and for SC/ST/PWD/EXS candidates is Rs. 50/-)

16. Pre-Examination Training (To be filled in only by those SC/ST/PWD/Religious

Minority Community candidates, who are desirous of taking Pre-Examination
Training)
Are you desirous of taking pre-examination training :
(Please indicate by putting √ in the appropriate BOX)

Yes No

17. Place of Birth : Town / Village ________________Tehsil _____________

District _________________ State _____________

18. Educational Qualification (From Class X onwards) (As on 01-01-2010)

Examination Name of the Board / Month & Year % of Class /

Subject Studied
Passed University of passing Marks Division
10th Std.
12th Std.
Graduation
Post Graduation
Others

19. Languages known (Please indicate by putting √ in the appropriate BOX)

S.No. Language Read Write Speak

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20. Particulars of Post Qualification Experience inclusing the Present Occupation / Job.

Name of the Period of service

employer(s)
Length of
firm etc. and Nature of Remarks
service
the nature and Designation duties (Reasons
Years,
details of and rank if any From To performed for leaving
Months,
activities in detail service)
Days
carried out by
the employer

21. Are you a native / domicile of Rajasthan ? If yesf, attach attested copy of domicile
certificate.
Yes No

22. Any other information : _______________________________

_______________________________

23. Before mailing application please check that you have furnished the following :

a) The post name and psot code you have applied for.
b) Category/Sub-category and have enclosed copies of necessary certificates
for SC/ST/OBC/PWD/EXS candidates.
c) Details regarding fees (Bank demand draft / Bankers Cheque)
d) Address for communication.
e) Separate application form with requisite fees for each post is sent.
f) Details for claiming relaxation in age and the relevant certificate is enclsoed.
g) Two self-addressed unstamped envelopes of 11 x 5 size.
h) An attested copy of Domicile Certificate is enclosed.
i) The envelop is to be susperscribed with the words “APPLICATION FOR THE
POST OF ______________________________Post Code No.
_______________Hadoti Kshetriya Gramin Bank Recruitment Project 2010.

DECLARATION

I hereby declare that all the statements made in this application are true, complete
and correct to the best of my knowledge and belief. I understand that in the event
of any information being found false or incorrect at any stage or not satisfying the
eligibility criteria according to the requirements of the relative advertisement, my
candidature / appointment for the said post is liable to be cancelled/ rejected at
any stage and if appointed, my services are liable to be cancelled/terminated. I
have not been debarred from taking up the test/selection by any bank/IBPS and I
have not been convicted in any criminal case. I am willing to serve any where, if
selected. I agree taht the Bank has the right to transfer me to any place at its
discretion.

I hereby agree that any legal procedings in respect of any matter(s) or claims or
disputes arising out of this application and/or out of the said advertisement can be
instituted by me only before the Courts / Tribunals / Forums at Kota and they also
shall have the sole and exclusive jurisdiction to try any case / dispute. I undertake
to abide by all the terms & conditions mentioned in the advertisement given by the
Bank and other further communication / intimation / notification with regard to this
recruitment.

Place :
Date : Signature of the Applicant