APPLICATION FORM
Address for Correspondences Permanent Address
Date of Birth (As per HSC) Age as on Date of Application
Phone/ Mobile Number & E- Mail ID Gender Nationality
Mother’s Name Father’s Name
Educational Details- Attach Self attested Photocopy of Certificates and Mark sheets
SL No Exam Passed Year of Passing Name of the Board/ University Subject Total Mark Secured Mark Mark Percent age of Mark
1 Matriculation
2 +2 CHSE
3 Graduation
4 Post Graduation
5 Other
*You may submit Circular/ Notification W.R.T Grade/ CGPA or any such kind of evaluation describing equivalent to secure mark from total mark as a reference document for computation of percentage for preparation of merit list.
Employment Details ( Previous) Attach Photo copies of Experience Certificate
Name of the Organization Designation Key Responsibilities Handled Period
From To
Current Employment – Attach proof of Current employment
Name of the organization Designation Responsibility Handled Working From Monthly Remuneration
Computer Literacy
Package/ Application Details of Exposure/ Proficiency
< < < <
Language Proficiency
Language Ability to converse Ability to read Ability to write
poor fair Good poor fair Good poor fair Good
English
Hindi
Odia
Bengali

Declaration:

I hereby declare that the above information furnished by me is correct, genuine and complete to the best of my knowledge and belief and nothing has been concealed or distorted.