DEPARTMENT OF FOOD, CIVIL SUPPLIES &CONSUMER AFFAIRS,

PUNJAB
APPLICATIONFOR THE POST OF……………………………………………….....
1. (a) Category
GEN SC/ST:OTHERS MAJ/BALMIKI BC

(b) Sub Category

ESM HANDICAPPED: OH HH VH FF SPORTS

2. Fee-DD/PO No. Dated Amount

3.Have you passed Punjab up to Matriculation Standard Yes No

4. Have you done 120 Hrs. Computer Courses as per notice Yes No

5. Percentage of Marks Obtained in Graduation

6. Experience as per Notice

Years Months Days
7. Sex M F 8. Date of Birth
Date Months Year

9.Age on 31.01.2011
Years Months Days

10.If Claiming Age Relaxation SC/ST BC ESM PH Pb Govt. Employee

Tick the relevant category

11.Candidate’s Name (in Capital letter)Please leave one box blank between first, middle & surname)

12.Father’s Name(in Capital letters)

13.Mother’s Name (in Capital letters)

14. Candidate’s Correspondence Address(in Capital Letters)

Name : ____________________________________
Father’s/Husband Name _______________________
Address ___________________________________
___________________________________
City/Town:__________________________________
State:_______________________________________
Pin Code
15. Candidate’s Address(in Capital letters)
Name : ____________________________________
Father’s/Husband Name _______________________
Address ___________________________________
___________________________________
City/Town:__________________________________
State:_______________________________________
Pin Code

16.Nationality

17.Are you Married Yes No

18.If yes, do you have more than one living wife Yes No

19. Educational and Professional Qualification

Examination Passed Name of Board/University Year of Passing Percentage of marks
/Institution obtained

20.Have you ever been dismissed from Govt. service of convicted by any Court Yes No

21.Deatils of documents attached 1. Matriculation Certificate (for proof of age)

2. Graduation Degree Certificate

3. If belonging to SC/ST, BC, ESM , PH , FF

Sportsperson category, attach proof thereof.

4. If claiming age relaxation , attach proof

/NOC From competent authority.

5 Bank Draft

I solemnly declare and affirm that the information given above is correct to the best of my knowledge
and belief.

Place:_____________ Date: _________________ (Signature of Applicant)