The Punjab State Cooperative Agricultural Development Bank Ltd.

,
Chandigarh
Manager/ Information Technology Officer/ Field Officer/ Clerk cum Data Entry Operator

Application for Retrenched Candidates

Name of the Candidate
Father's/Husband Name
Mother Name
Gender

Photo

Date of Birth
Age
Nationality
Email
Mobile Number
Phone
Category
Domicile
Physically Handicapped

Yes/No

Are you Married

Yes/No

if Yes, do you have more than one

living wife
Have you ever been dismissed
from Govt. Service or convicted by
any court?
Passed Punjabi

Yes/ No

Retrenched from ............................................ Closed Coop. Sugar/Spinning Mill in Punjab State

Address for Correspondence

Permanent Address

Educational Qualifications
Qualification

Course
Details/Specialization

Name of University/
Institution

Year of
Passing

Marks in % / Grade

List of Enclosures
1.
2.
3.
4.
5.

I hereby declare that all the statements made in this application form are true and correct to the
best of my knowledge and belief. I understand that action as deemed fit can be taken against me by
the competent authority, if i am declared by them guilty of any type of misconduct on account of
wrong, false or incomplete information and documents and shall be solely responsible for such an
action.

Signature of the Candidate

Date: