Format for Application

To
The General Manager, Vehicle Factory Jabalpur (M.P.), Pin-482009

Sub: Application for the post of Trade code(As per advertisement) Ref: Advertisement No . Date ..Published in. 1. Full Name (in English Block letters (As written in SSC Certificate) 2. Father's/Husband's Name :English (Block Letters) 3. Nationality.

4. Sex : (code for Male-01 & for female-02) 5. Date of Birth: D D MM Y Y Y Y (Attested copy of school certificate/birth Certificate showing Date of birth to be enclosed) 6. Age as on the last date of submission of Application : YearsMonths.Days 7. Ex-Trade Apprentice of Ordnance Factory (Code For YES-01, For NO-02) If yes (a) Name of Factory : (b) Batch No: (c) T. No. : (d) Period of Apprenticeship From To .. (No. of Years..) (e) Date of passing NCVT : 8. (A) Category Code : (For GEN-01, SC-02, ST-03 & OBC-4) (B) Whether PH or Ex-Servicemen : (Code For PH-05 and Ex-servicemen-06) 9. Correspondence Address:
House No Mohalla/village Post office Distt state Pin

10. Nearest Railway station : 11. Employment Exchange Registration No. & Date, If any : No:Date: 12. Particulars of Fee:
DD Issuing Bank Name & Address / IPO Issuing PO Name & Address / Issuing Date

DD/IPO NO.

Amount

13. (a) Educational Qualification & Other Qualification : . (Attested copies of all marks sheet and certificate to be enclosed):-

Name of Examination passed

Year of passing

Name of Board/ university

Subject & Trade studied

Percentage of Marks

(b) Whether NCTVT/ ITI/ equivalent Diploma /certificate : (code For NCTVT-01, ITI-02, Eq. Dip./Cert.-03) 14. Experience, if any (attested copies of all certificate to be enclosed):Post Held Name of organization Period From To Nature of duties performed Pay scale of salary drawn Reason for leaving Remarks

15. Ex-serviceman (Attach copies of Ex-Serviceman Certificate Issued by Competent Authority and discharge certificate should be enclosed):Name of unit/Corps. Date of Enrolment/ Date of Appointment Date of Discharge Length of service

16. Whether Departmental candidate/ Employed in Govt./PSUs etc. if yes, give details (No objection Certificate should be enclosed)
Name of Dept/Office Designation & pay scale Personal No. & Section (If any) Nature of duty performed Length of service

17. For Physically Handicapped .. (Mention the type & Percentage of disability) (The minimum degree of disability in order for a person to be eligible is 40%. Attested copy of PH certificate obtained from competent Authority should be enclosed). Categories of disability suitable for the job:(i) Machinist : One Leg, Partially Deaf and Deaf. (ii) Fitter Genl : One Leg , both legs, partially Deaf and Deaf (iii) Grinder : One Leg ,partially Deaf and Deaf. 18. Medium of written Test to be conducted: (Code For Hindi-01 & For English-02) 19. List of all enclosures:1. Proof of Date of birth 2. Factory Apprenticeship Certificate 3. Educational qualification certificate 4. NCTVT Certificate/ITI Certificate 5. Caste certificate 6. IPO/DD 7. Other Related documents Place: Date:

Signature of the candidate: Name of the Candidate:

Declaration by all candidates (a) I hereby declare that all the statements made in this application are true, complete and correct to the best of my knowledge and belief, in the event of any information being found false/ incorrect and/or any document being found dubious/bogus and or my ineligibility being detected any time either before or after the trade test/written test my candidature will stand automatically cancelled. (b) In the event of my selection, I hereby give an undertaking that I will be willing for, redesignation to any equivalent trade/ post in the exigency of service. Place: Date:

Signature of the candidate: Name of the Candidate:

Declaration by OBC Candidates only

I.. Son/Daughter of Shriresident of village/town/cityDistrict..State. hereby declare that I belong to the..community which is recognized as a backward class by the Government of India for the purpose of reservation in service as per orders contained in Department of personal and Training Office, Memorandum No. 36012/22/93-Estt. (SCT) dated 08-09-1993, and as amended. It is also declare that I do not belong to persons/ sections (creamy Layer) mentioned in column 3 of the schedule to the above referred office Memorandum, dated 08-09-1993 and as amended. Place: Date:

Signature of the candidate: Name of the Candidate: