APPLICATION FORM

The Managing Director, RajCOMP Info Services Limited, C-Block, 1ST Floor, Yojana Bhawan, Tilak Marg, C-Scheme, Jaipur 302 005
Paste here your recent passport size colour photograph & sign it across

With reference to your advertisement in the -----------------------------------------------------(news paper) dated ------------------------------, I submit my application in the prescribed format. 1. FULL NAME IN BLOCK LETTERS: (leave one space blank between two parts of your name) Mr./Mrs.
(As it appears on your educational certificates)

2.

CANDIDATE ADDRESS FOR CORRESPONDENCE:

Pin Tel. No.: (with STD Code) Mobile No.: E-Mail: 3. 4. POST APPLIED FOR: INDICATE CATEGORY TO WHICH YOU BELONG: GEN Other Category (specify the category) Reserved Category Applicant enclose attested photocopy of certificates: (i) Name of the caste/tribe/class _______________ 5. (ii) Name of the state to which you belong _______________ _________________________ _________________________ _________________________

PARTICULARS OF APPLICATION FEE (DEMAND DRAFT): Name & address of the Drawn in Date DD number issuing Bank favour of of Issue

Amount

(Fee for each post is Rs.100/- for General Category candidates)

6.

(a) DATE OF BIRTH:

(as per SSC/Class X Certificate enclosed )

Date

Month

Year

(b) Age as on 01.01.2014: (c) Place of Birth: 7. 8. 9. 10. GENDER Male Years Months Days Town __________ District _____________ State _____________ Female (mark "" in appropriate box)

MARITAL STATUS NATIONALITY EDUCATIONAL & PROFESSIONAL QUALIFICATION: MATRICULATION/SSC ONWARDS: (as on 01.01.2013)
Examination Passed Name of the Institution/ University Subjects studied in detail Date, Month & Year of Passing Percentage of aggregate marks

(Attested photocopy of above-mentioned examination/degree to be enclosed with this application)

11.

PARTICULARS OF EXPERIENCE AS ON 01.01.2013:

Name of the employer's etc. & details of activities carried out by the employers Designation Period of Service From To Length of Service Year Month Nature of duties performed in detail Remarks (reasons for leaving service)

(Attested photocopy of relevant experience certificate to be enclosed with this application)

12. 13. 14.

FATHERS NAME:
(IN BLOCK LETTERS)

MOTHERS NAME:
(IN BLOCK LETTERS)

PERMANENT ADDRESS OF THE CANDIDATE:

Pin 15. LANGUAGES KNOWN: (mark "" in appropriate box) (A) ____________ (Read) (Write) (Speak) (B) ___________(Read) (Write) (Speak) (C) _____________ (Read) (Write) (Speak) (D) ___________(Read) (Write) (Speak) 16. ANY OTHER RELEVENT DETAILS (May attach separate sheet if required): ............................................................................. ................................................................................................................................................ ................................................................................................................................................
17.

REFERENCES :

1. 2.

________________________ ________________________

I hereby declare that all statements made in this application are true, complete & correct to the best of my knowledge and belief. I understand that in the event of any information being found false or incorrect at any stage or not satisfying the eligibility criteria according to the requirements of the relative advertisement, my candidature/appointment is liable to be cancelled/terminated. I am willing to serve anywhere in Rajasthan. I agree that RajCOMP Info Services Limited has the right to transfer me to any part of the state at its discretion. I hereby agree that any legal proceedings in respect of any matter(s) or claims or disputes arising out of the application and/or out of the said advertisement can be instituted by me only at Jaipur and Courts/Tribunals/Forums of Jaipur only shall have sole and exclusive jurisdiction to try and cause/dispute.

Place: _______________ Date: _______________ SIGNATURE OF CANDIDATE