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2 fdlh ,sls mEehnokj dks ftlds ekeys esa ik=rk dk izek.k&i= vko;d gks bl
ckr ds v/;/khu vafre :Ik ls fu;qDr fd;k tk ldsxk fd jkT; 'kklu }kjk mlds i{k esa
vko;d izek.k&i= varr% tkjh dj fn;k tk,A
II ,sls vH;FkhZ tks e/;iznsk ds LFkkbZ fuoklh ugha gS] flQZ vukjf{kr@vksiu ds
vUrxZr fjDr inksa gsrq gh viuk vkosnu izLrqr dj ldrs gSaA ,sls vkosndksa dks
vkj{k.k vFkok vk;q lhek esa NwV dk dksbZ Hkh ykHk ugha feysxk rFkk mudh vk;q
lhek 01 tuojh 2013 dkss U;wure 18 o"kZ ,oa vf/kdre 40 o"kZ gksuk pkfg,A
4-2 vkosndksa ds fy, vk;q lhek %&
e/;iznsk 'kkklu] lkekU; izkklu foHkkx ds i= - lh&18&15@91@3@1] fnuakd
03@02@1992 ds vuqlkj vH;FkhZ dh vk;q lhek 01 tuojh 2013 dks 18 o"kZ ls de ugha
gksuk pkfg,A e/;iznsk 'kklu] lkekU; izkklu foHkkx ds i= - lh 3&11@12@1@3
fnuakd 03@11@2012 ,oa - lh 3&11@2012@3@,d fnukad 20@11@2012 ds
vuqlkj vf/kdre vk;q lhek ,oa fofHkUu laoxksZ ds varxZr vkus okys vH;kFkhZ dks vf/kdre
vk;q lhek esa fuEukuqlkj vk;q esa NwV iznku dh xbZ gS %&
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lkekU; vukjf{kr
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'kkldh;@fuxe@e.My @Lo'kklh laLFkk
ds deZpkjh rFkk uxj lSfud
vkjf{kr & vuqlwfpr tkfr@vuqlwfpr
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tutkfr@vU; fiNM+k oxZ
vkjf{kr oxZ & 'kkldh;@fuxe@
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ds deZpkjh rFkk uxj lSfud
fo/kok@ifjR;Drk@rykdkqnk
vkjf{kr & vuqlwfpr tkfr@vuqlwfpr
tutkfr@vU; fiNM+k oxZ
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4-3 e/;izns'k ds LFkkbZ fuoklh vkosndksa esa] ifjokj dY;k.k dk;Ze vUrxZr xzhudkMZ/kkjh]
vkfne tkfr] vuqlwfpr tkfr ,oa fiNM+k oxZ dY;k.k foHkkx dh vUrtZkrh; fookg
izksRlkgu ;kstuk esa iqjLd`r naifRr;ksa ds laoxZ lgHkkxh] foe iqjLdkj ls lacaf/kr
f[kykfM+;ksa] fu%'kDr&tuksa] HkqriwoZ lSfudksa ,oa NVuh fd;s x;s deZpkfj;ksa ds laca/k esa] vk;q
lhek gsrq] e/;izns'k 'kklu] lkekU; iz'kklu foHkkx }kjk le;≤ ij tkjh fd;s x;s
rRlaca/kh funsZ'k izHkko'khy gksaxsA
uksV % lHkh izdkj dh NwV dks 'kkfey djrs gq, fdlh Hkh fLFkfr esa fdlh Hkh izoxZ ds fy,
vf/kdre vk;q&lhek 45 o"kZ ls vf/kd ugha gksxhA
4-4 vugZrk,W %&
1 dksbZ Hkh mEehnokj ftlus fookg ds fy;s fu;r dh x;h U;wure vk;qiq:"k
21 ,oa efgyk 18 o"kZ ls iwoZ fookg dj fy;k gks] fdlh lsok ;k in ij
fu;qfDr ds fy;s ik= ugha gksxkA e/;iznsk flfoy lsok vkpj.k fu;e] 1965
esa fn, d, izko/kku vuqlkj
2 dksbZ mEehnokj ftldh nks ls vf/kd larku gS] ftlesa ls ,d dk tUe 26
tuojh 2001 ;k mlds Ikpkr gks] fdlh lsok ;k in ij fu;qfDr ds fy;s
ik= ugha gksxkA
3 ij:i/kkj.kA
4 dnkpj.k laca/kh nks"kh fl) gksus ijA
5 vU; vugZrk,W lkekU; izkklu foHkkx] e/;iznsk 'kklu ds fu;ekuqlkjA
4-5 tkfr izek.k&i= %&
e/;iznsk ds ewy fuoklh vkjf{kr oxZ ds vkosnd ds ikl lkekU; izkklu foHkkx
}kjk fu/kkZfjr izk:Ik esa vuqfoHkkxh; vf/kdkjhjktLo }kjk tkjh LFkkbZ tkfr izek.k&i=
gksuk vko;d gS] ftls fu;qfDr ds le; lR;kiu gsrq izLrqr djuk gksxkA
4-6 fodykaxrk izek.k&i= %&
e/;iznsk ds ewy fuoklh fodykax ds ikl esMhdy cksMZ }kjk fu/kkZfjr izk:Ik esa
l{ke vf/kdkjh }kjk tkjh fodykaxrk izek.k&i= gksuk vko;d gS] ftls fu;qfDr ds le;
lR;kiu gsrq izLrqr djuk gksxkA
4-7 HkwriwoZ lSfud dk izek.k&i= %&
e/;iznsk ds ewy fuoklh HkwriwoZ lSfud laoxZ ds vkosnd ds ikl 'kklu }kjk
fu/kkZfjr izk:Ik esa l{ke vf/kdkjh }kjk tkjh izek.k&i= gksuk vko;d gS] ftls fu;qfDr ds
le; lR;kiu gsrq izLrqr djuk gksxkA
4-8 ikjLifjd izkoh.;rk %&
Pk;u esa leku vad izkIr djus okys mEehnokjksa dh ikjLifjd izkoh.;rk vk;q ds
vk/kkj ij fu/kkZfjr dh tkosxh vFkkZr~ vk;q esa ofj"B vH;kFkhZa dks ojh;rk nh tk,xhA
4-9 fu;qfDr dh Tkkudkfj;k ,oa 'krsZa %
1- MkVk ,UVh vkWijsVj lg dk;kZy; lgk;d lg ih-Mh-,- vkWijsVj ds inksa Ikj
inLFkkiuk e/;izns'k dh tuin iapk;rksa esa] muds eq[;ky;ksa esa dh tkuk gS fdUrq
vko';drkuqlkj ftyk eq[;ky;@jkT; eq[;ky; ij Hkh inLFkkiuk dh tk ldrh
gSA
2- lafonk fu;qfDr vkns'k esa nf'kZr fnukad rd dk;ZHkkj xzg.k djuk vfuok;Z gksxk
vU;Fkk vkns'k fujLr ekuk tk;sxkA
3- kjaHk esa lafonk vof/k ,d o"kZ gksxhA rRi'pkr~ dk;Z ewY;kadu ,oa dk;Z
vko';drk ds vk/kkj ij] mi;qDr gksus ij ,d&,d o"kZ ds fy, iqu% lafonk
fu;qfDr c<+kbZ tk ldsxhA
20- p;fur vH;FkhZ] mldh inLFkkiuk ds LFkku ij dk;ZHkkj xzg.k djus ds fnukad
ls lafonk esa ekuk tkosxkA ;fn lafonk ij fu;qDr dksbZ O;fDr fcuk fdlh fof'k"V
dkj.k ds vkSj fcuk fdlh lwpuk ds vius drZO; ls 01 ekg ls vf/kd ds fy;s
vuqifLFkr jgrk gS rks mldh lafonk fu;qfDr ,slh vuqifLFkfr ds fnukad ls Lor%
lekIr ekuh tkosxhA
21-lafonk fu;qfDr ij fu;qDr MkVk ,UVh vkWijsVj lg dk;kZy; lgk;d lg ih-Mh,- vkWijsVj dh lsok,a fu/kkZfjr vof/k ds iwoZ fcuk dksbZ dkj.k crk;s ,d ekg dk
uksfVl nsdj vFkok ,d ekg dk lafonk osru nssdj lekIr dh tk ldsxhA
22- lafonk ij la;kstu ds mijkar] pfj= lR;kiu 'kkldh; lsodks ds fy;s ykxw
fu;eksa ,oa vuqnskksa ds vk/kkj ij fd;k tkosxkA pfj= ds laca/k esa fdlh izfrdwy
fu"d"kZ dh nkk esa] lafonk fu;qfDRk fcuk dksbZ dkj.k nkkZ;s vfoyac fujLr@lekIr
dh tkosxhA
23- lafonk esa la;ksftr deZpkjh ds dnkpkj ;k fdlh vkijkf/kd fdz;kdyki esa
layXu gksus ij lafonk fu;qfDr lekIr dj nh tkosxhA
24- lafonk ij fu;qDr MkVk ,UVh vkWijsVj lg dk;kZy; lgk;d lg ih-Mh-,vkWijsVj ,d ekg dk iwoZ uksfVl nsdj vFkok ,d ekg dk ikfjJfed uxn tek
dj lafonk lsok ls R;kxi= ns ldrk gSA
25- e/;iznsk 'kklu }kjk le;≤ ij lafonk fu;qfDr ds laca/k esa tkjh
vknsk@lakks/ku bl fu;qfDr ij ykxw@ca/kudkjh gkasxsA
26- fookn dh fLFkfr esa eq[; egkizca/kd vkokl }kjk fu.kZ; fy;k tkosxkA bl
fu.kZ; dh vihy eq[; dk;Zikyu vf/kdkjh e-iz- xzkeh.k lM+d fodkl izkf/kdj.k]
Hkksiky dks dh tk ldsxhA
27- LFkku ifjorZu % lafonk ij la;ksftr fd;s x;s deZpkfj;ksa ds LFkku ifjorZu ds
fy;s e/;iznsk 'kklu] iapk;r ,oa xzkeh.k fodkl foHkkx }kjk RkRlaca/k esa tkjh dh
xbZ LFkku ifjorZu uhfr&twu 2012] v|ru lakks/kuksa ds lkFk izHkkokhy jgsxhA
4-12 ;k=k fdjk;k %&
vkjf{kr Js.kh ds vH;kfFkZ;ksa dks lk{kkRdkj gsrq cqyk;s tkus ij] fVdV izLrqr fd;s
tkus ij] jkT; 'kklu ds fu;ekuqlkj ;k=k O;; dh izfriwfrZ Hkqxrku ijh{kk dsUnzksa
ij ijh{kk mijkar lacaf/kr ftyk iapk;r }kjk fd;k tkosxkA
Advertisement No.
Application form No
.
Application form
dated
(On contract)
1. Name of the post (Applied for) :
P.P. size photo
2. District code no.
:
graph attested by
(i.e. s. no. of district in advertisement)
a Gazatted Officer
3. Name of applicant
:. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . ..
(Name)
4. Father's name
(Surname)
:
(Name)
(Surname)
5. Permanent address
:
PIN.
6. Present address
:
PIN.:.
(Address proof : Enclosure 1)
7. Date of birth
:. . . . /. . ../ . . . . . . . (In words .. . . . . . . . . . . . . . . . . . . . .)
(Attested true copy of marksheet of Higher Secondary School Certificate Examination
/equivalent examination exhibiting date of birth : Enclosure 2)
8. Age as on 01/01/2013
: Years Months . Days
9. Category (Please tick)
: Unreserved/ OBC/ SC/ ST
(Attested true copy of caste certificate in case of OBC/SC/ST candidate : Enclosure ..)
10. Home district
:
11. Educational qualification details :
Year of
Subject
Marks
Description
Name of
Institution
Passing
Obtained
Examination
Board
Total Marks
University
Matriculation
Graduation
Computer
Education
Others
12 Experience details :
S.
No.
Name of Institution
Nature of work
Period of
Experience
Duration
Enclosure
(In Month)
From to
1
2
3
4
Total duration
Declaration
I hereby declare that no criminal proceedings of any nature is pending consideration against
me. I further declare that information supplied by me in, the application form, its supplementary parts
and enclosure annexed to it; are true to the best of my knowledge & belief. My selection to the post
may be cancelled and suitable action may be taken, if information furnished by me shall be found false
or incorrect at any point of time in future.
Date :. . . . . . .. .
(Signature)
Name of the applicant: . . . . . . .. . . . . . . . . . . . . . . .
Place :. . . . . . .. .