Af DR

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APPLICATION FOR THE POST OF__________________________________ 1. 2. 3. 4. 5. 6. 7. 8.

Name: Date of Birth & Age: Address for Communication: Contact Phone No. /Email: Fathers/Husbands name: Languages known (underline mother tongue): Caste (if belonging to SC/ST/OBC: Qualifications (Educational & Professional): S. Course of Study Dates No (Beginning from attended . 10th Std.) (Years) (including From To professional training) Degree/ Diploma/ Certificate awarded Percenta ge of Marks/ Grade obtained

Passport Size Photo

9.

Experience Sl Name & . Address of N Employer o.

Post held

Pay Scale and Total Salary drawn

Period From To

Nature of Duties/Wor k attended

10. Any other Information:

Date: ____________ Place: ________________________

SIGNATURE

Note: Attested copies of certificates in support of age, educational/professional qualification, experience and caste (indicating whether the candidate belongs to the non-creamy layer of the Other Backward Class) may be enclosed.

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