Application form for the post of Personal Assistant 1. Name of the candidate (in BLOCK letters) 2.

Name of the Deptt./Institute/Directorate where working now 3. Present post held 4. Whether temporary or permanent on present post 5. Date of appointment to the present post 6. Present Basic pay and grade Pay 7. Address for correspondence 8. Personal contact details: (a) Telephone No. (b) Mobile No. (c) Fax No. (d) E-mail address: 9. Date of Birth

........................................................... ........................................................... ........................................................... ...........................................................

10. Educational qualification (Furnish details of examinations passed from Matriculation onward) Exam passed Subject (s) Board/University Year passing of % of marks obtained

11. Experience/Service particulars: Name of Institute/Organization Post held Scale of pay From Period To Nature of duties performed/performing

12. Any other specific information: I do hereby declare that the particulars furnished by me above are true and correct to the best of my knowledge and belief. Date ............................ Signature

Certificate by the employer It is certified that the particulars furnished by the officer/official as per records held in this office. No disciplinary/vigilance case is pending or being contemplated against the officer/official. The Attested copies of ACRs of the officer/official for the last 05 years are enclosed, as required.

(Signature of the officer with Deg. & Seal)