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WEST CENTRAL RAILWAY

Personnel Department
Divisional Railway Managers Office,
Jabalpur

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APPLICATION FORM FOR THE POST OF PARA MEDICAL STAFF ON

CONTRACT BASIS.
Passport size
Photograph

Category of post applied for

:_____________________

1.

:____________________________________

2.

Name of Applicant
(In Capital Letter)
Fathers Name

3.

Date of Birth

:____________________________________

4.

Age as on 01.07.2015

: Year________ Month________ Days__________

5.

Category (SC/ST/OBC)

:_________________________ (Attach Certificate)

6.

Permanent residential Address :_______________________________________

____________________________________

7.

Address for correspondence

:____________________________________

:____________________________________

____________________________
8.

Telephone/Mobile No. if available :______________________(With STD code)

9.
Educational Qualifications :
S.
Exam. Passed
Name of Board/State
No.

Passing
Year

10.
Technical Qualification :
S.
Name of
Name of
Council/
Passing
No. Course
Institution University Year
Affiliated

Percentage of
marks obtained

Percentage Registration
of marks
Number etc.
obtained

11.

Extra Qualification or Experience, if any ________________________________

12.

Present employment, if any ____________________________________________

13.

Identification marks (i). ________________________________________________

ii)._________________________________________________

Declaration : I hereby declare that the facts and evidences given by me in the above
application are true, complete and correct to the best of my knowledge and belief. In the event
of any mis-statement/discrepancy in the particulars being detected at any stage, my
candidature/service may be cancelled/ terminated without any notice. I am aware that this is
purely on contract basis and I will not claim for regular appointment.
Place :
Date :
Attested copies Attached.
1.
2.

(Signature of candidate)
3.

4.