Application No : Date & Time : 01/01/1970,

To
The CDPO
ICDS Project
District
Subject : Prayer for consideration of sponsoring name for recruitment of Supervisors
Sir / Madam,
In response to your notice this is to request you that I have attained eligibility for candidature to recruitment for Supervisor
under ICDS Scheme.My personal details along with certificates are attached for kind consideration.

ICDS Centre Details

Anganwadi Center Name( AWCS Name ) : AWCS Code :
Personal Details
Worker Name : Mobile No. :
Father's Name : Mother Name :
Date of Birth : 01/01/1970 Age : Y. M. D.
Marital Status :
Address Details
Address : Pincode :
Post Office : Police Station :
District : State : WEST BENGAL
Joining Details where she joined first as Anganwadi Worker
Date of Joining : 01/01/1970 Experience in years : Project Name :
Education Details
Sl. No. Examination passed Name of Board/ University Year of Passing Marks obtained
Disability Status Details
Wheather person with disability :
Miscellaneous Details
Meritorious Sports
Caste : Personality
:
Particulars furnished above are true to the best of my knowledge and I do hereby undertake that if any of the information
furnished is found incorrect,my candidature may be rejected.
May I be allowed to appear the examination for recruitment of Supervisors under ICDS
Documents in hard copies to be submitted with the signed copy of system generated online application is given below

1) Age Proof - Madhyamik or equivalent certificate.    2) Id proof stating residential address.    3) Caste Certificate details for SC/ST/OBC A/OBC
B.      4) Document for Meritorious Sport Personality (If yes).      5) Proof of Educational Qualification Details and Examination Passed Mark
sheet.    6) Certificate from CDPO of first Project Stating date of joining.    7) Disability Certificate and ID card details for person with disability
candidate.

___________________________________
Applicant's Signature & Date
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For Official Use only
Application Id :
Applicant Name :
Application Date : 01/01/1970
Hard Copy received Date :
Hard Copy received Time :
____________________________________
CDPO Signature with Seal