Application for recruitment to the post of ………………….

1. Applicant’s Name :
2. father’s/ Husband’ Name:
3. Nationality :
4. Addressed for correspondence :
5. Date of Birth :
6. Age as on last date of receipt of application : Years Months Days
7. Category : UR SC ST OBC PH EX- SER

8. Educational Qualification :

Exam Passed Years School/ Board/ University

9. Experience

Designation/post Time period Duration School

Declaration:
I hereby solemnly declare that the above information is correct to the best of my
Knowledge and nothing has been concealed distorted. If at any time, I am found
To have concealed/ distorted any material information my appointment shall be
Liable to be summarily terminated.

Date: Signature of the applicant

Davp 10801/11/0071/1011 EN32/79