1. Name in full : (Mr./Ms.) : (As per SSLC certificate)
2. Fathers Name :
3. Age & Date of birth :
4. Gender: M/F :
5. Nationality :
6. Category-General/SC/ST/OBC : (Enclose Certificate in the prescribed format)
7. Demand Draft No. :
8. a) Indicate if you are a Physically Disabled Person:
If yes, indicate nature of Disability (Disability certificate in the prescribed format to be enclosed)
b) Degree of Disability :
9. Religion: Hindu / Muslim / Christian / Sikh / Neo-Buddhist / Zoroastrian, others (please specify) :
10. a) Hobbies / Special Interests :
b) Whether participated in NCC/Scouts/Cultural activities/Debate/ Competition / Sports etc. (Please specify) :
OH VH HH
Affix your Photograph (optional) 11. Qualification: (Academic / Professional) (Indicate division & year of passing)
Educational status from SSLC onwards Institution/University Main subject Class secured/ Percentage of marks Year of passing
12. Details of Experience :
13. Address (Pin Code, email id and phone no. are mandatory fields)
PERMANENT CORRESPONDENCE
Phone No.(With STD Code):
Phone No.:
Mobile No:. Email address:
Sl. No. Name of the Organisation From To Designation Nature of responsibilities in brief
14. Details of relatives employed in BEL, if any
Name Relationship Designation Department Unit
15. Have you appeared for any previous selection for Appointment in BEL? If so, please furnish details in brief:
16. Undertaking
I affirm that the information given above is true and correct. I further declare that if any at stage it is discovered that an attempt has been made by me to willfully conceal or mis-represent facts, my candidature may be summarily rejected or my employment terminated.
The National Council On Disability (NCD) Deny Being in Possession of Records Pertaining To Britney Spears Perturbing Conservatorship - # W (AACL) - # Michael A. Ayele