APPLICATION FORMAT
Assistant Personnel Officer,
Diesel Loco Modernisation Works (DMW),
EMPLOYMENT NOTICE NO.001/2012
APPLICATION FOR APPOINTMENT FOR
ERSTWHILE GROUP ‘D’ POST AGAINST SPORTS
QUOTA
1. Name
of the Candidate (in Block Letters) :
…………………..
2. Father’s
Name :
…………………..
3. Address
for communication :
…………………..
……..……………..
…………..………..
…………..………..
3. (a) Mobile
No./Phone No. (with STD code) : …………………..
4. (a)
Date of Birth :
…………………..
(b) Age as on 01.01.2013 : …………………..
(c) Sex (Male or Female) :
…………………..
5. Nationality :
…………………..
6. Religion :
…………………..
7. Nearest
Railway Station : …………………..
8. State
whether you belong to SC/ST/OBC :
…………………..
(Proof to be attached)
9. Name
of the Event / Game played :
…………………..
& Position / Specialty: (a) Event / Game : …………………..
(b) Position : …………………..
(c) Specialty : …………………..
10. Sports
achievements (indicating Event and Position :
…………………..
achieved) in the discipline
(copies of the self …………………..
attested certificates in support
of ranks / position …………………..
secured to be enclosed) …………………..
11. Educational
Qualification (copies of self attested certificates to be enclosed)
Sl. No.
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Examination Passed
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Name of the
Institution / Board
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Year / Month of
Passing
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12. If
already employed, give particulars
(a) Name of the
organization :
…………………..
(b) Post held :
…………………..
(c) Employed :
From To
(Application should be forwarded
through proper channel with proper N.O.C.)
13. Details
of “Indian Postal Order / Demand Draft
|
I.P.O. / DD No. /
Date
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Issuing Post Office
/ Bank
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Value (Rs.)
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DECLARATION
I hereby
declare that all details furnished in this application are true and correct to
the best of my knowledge and belief. I understand that in the event of
particulars or information given herein being found false or incorrect, my
candidature for the recruitment against sports quota is liable to be rejected
or cancelled. In the event of my mis-statement / discrepancies in the
particulars being detected after appointment, my services shall be terminated
without any notice to me.
Place: Signature of the Candidate
Date: (Name: )
Note: Affix your recent passport size self attested photograph in right side top corner of the application.
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