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CANDIDATE IS REQUESTED TO RETAIN THE PRINTOUT OF CONFIRMATION PAGE FOR FUTURE REFERENCE.
Personal Details
16
Mobile Number xxxxx35660 Email xxxxxPARIDA1@GMAIL.COM
Name of the Registered Employment DISTRICT EMPLOYMENT City & State of Registered
Exchange Employment Exchange
DHENKANAL
EXCANGE DHENKANAL
PwBD Candidate (With 40%
NO
AL
Disability)
EX-Service Men NO
Contact Details
Permanent Address
Experience Details
Training Details
Industry Nature of Training
NAL24009616_14_e8ab4e58-
Payment Mode SBI Transaction ID
06f4-4654-8820-cbf0e81c1221
Declaration
I do hereby declare that all statements/ information in the application are true, complete and correct to the best of my knowledge and belief. In case it is detected at any
stage of recruitment/ after appointment that I do not fulfill the eligibility norms and/ or that I have furnished any incorrect/ false information or have suppressed any facts,
my candidature/ appointment will automatically stand cancelled, and would be deemed to be void ab initio. I understand that my candidature will be provisionally
considered if this application form, duly completed in all respects is submitted within the notified last date as per the advertisement.
Signature