Home Online Application Form Post Details : Advertisement No. * : 2/2013 Category No.

* : 29Name of Post * : Junior Engineer (Civil) Personal Details (as per matriculation certificate) : Candidate Name*: * Father's/Husband's Name*: * Mother's Name*: * Date of Birth(dd/mm/yyyy)*: * Invalid Date Format. Age As On Eligibility Date.* : * Mailing Address : Address* : * City* : * District* : * State* : Select... Andaman & Nicobar Islands (UT) Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh (UT) Chhattisgarh Dadra & Nagar(UT) Daman & Diu (UT) Delhi Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Lakshadweep(UT) Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Pondicherry(UT) Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttaranchal West Bengal * Pin Code* : * Other Details : Have you passed Hindi/Sanskrit upto Matriculation * : --Select-- Yes No * Nationality* : --Select-- Indian Other * * Sex* :MaleFemale * Area* :UrbanRural * Marital Status* :Un-MarriedMarried * Widow Divorce Destitute Non Are you domicile of Haryana* : Yes No Category* : General SC BCA BCB SBC EBPG ESM DESM DFF OSP No Are you Physical Handicap of Haryana* : Yes No Physical Handicap Sub-Category : Ortho LowVision Blind D & D

Note : The candidates belonging to ESM/DESM/DFF/OSP/PHC will be required to select both the coloumns i.e. Category as well as caste which they belong. Are you employed in Govt /Public Sector Undertaking* : (If yes and you are in regular service then give details and have to submit NOC from the Employer at the time of interview) Yes No Contact Number* : * Email* : * Email Id is not valid Confirm/Re-Enter Email* : * Email Id not matched Visible identification mark on the body of the candidate* : * Select Bank Name for E-Challan* : Bank of Patiala * --Select-- SBP-State

Education Qualification : ExaminationStream(i.e.10th /B.Sc/M.Sc/etc)Board/ UniversitySubjectYear Of PassingMarks ObtainedTotal MarksMarks in %Division (1/2/3) Matriculation * Year 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Intermediate Year 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 ITI/Vocational Year 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Diploma Year 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Graduation Year 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Post Graduation Year 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Other Qual. (If Any) Year 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

2007 2008 2009 2010 2011 2012 2013 Reason For Gap ( If Any) : Experience Details : Organization NameDesignationFrom DateTo DateTotal Exp.Nature of DutiesSalary Per Month

Documents Available With You In Support Of Your Eligibility For This Post : Matriculation Certificate with Marksheet copy Intermediate Certificate with Marksheet copy Graduation Degree with all Marksheets copy Post Graduation Degree with all Marksheets copy All Other Qualification Degree with all Marksheets copy Experience Certificate copy Copy of Challan/E-Challan Caste Certificate Haryana Resident Certificate ESM/ DESM/ DFF Certificate Physically Handicap Certificate Gradation Certificate in case of OSP Note : All Document Must Be Issued Before Clossing Date of Advt. Upload Photo & Signature : If the Upload Photo / Signature is not loaded in appropriate place, your application is liable to get rejected Allowed Photo Size - 20KB to 50 KB File Type : *.jpge, *.gif Allowed Signature Size - 10KB to 20 KB File Type : *.jpge, *.gif Upload Photograph* : * Upload Signature* : *

Declaration : I hereby declare that :1. All statements made in this application form are true, complete and correct to the best of my knowledge and belief. In the event of any information being found false or incorrect, or ineligibility being detected before or after the interview/appointment/selection, my candidature may be cancelled and action can be taken against me. 2. I have read the provisions/instructions in advertisement of the Commission carefully and I hereby undertake to abide by them. I fulfill all the conditions of eligiblity regarding age limits, educational qualifications etc, prescribed in the advertisement and other relevant rules and instructions.

3. I agree.

I have never been convicted by Criminal Court.