APPLICATION FOR APPOINTMENT ON CONTRACT BASIS

FOR THE POST OF_____________

1. Name of the Candidate (in Block Letters) :

2. Fathers/Husands Name :


!. "ate of Birth (as #er $$C records) :

%. a) &ualifications.. 'cademic and (echnical (from $$C on)ards)
('ttested *hotostat in su##ort of +ualifications ,ith marks memos)


&ualification
,ith
-rou#/Branch
Name of the
.nstitution and
Board//ni0ersit1
(otal
marks
2arks
$ecured
3 a-e of
2arks
secured
4ear of
*assin-



() Hi-her &ualifications (2.*hil/ *h"/N5( or $L5()

Name of
the
"e-ree
Name of
the
.nstitution
2arks
$ecured
3 a-e of
2arks
secured
4ear of
*assin-
Branch





Note: - (he candidates )ho #ossess the #ro0isional certificate at the time of a##l1in-
itself shall e eli-ile to a##l1.
(hose )ho are #ursuin- hi-her studies shall not e considered to e #ossessin-
hi-her +ualifications unless #ossess the #ro0isional or ori-inal certificate as on the
date of sumission of a##lication.



6. 57#erience :

$l.No Name of the
8r-anisation 9
'ddress )ith
*hone.No
*eriod of
$er0ice
(otal
$er0ice in
4ears and
months
:eason
for
lea0in-
:eference
#erson address
and contact
numer
From (o



;. Communit1 $C/$(/BC<'/B/C/"/5 :
(co#1 of caste certificate shall e enclosed)





Affix a
recent
passport size
photograph





=. Name of the 5ducational .nstitutions )here studied
From Class .> to ? @ enclose stud1 certificate/certificate of residence in the
#rescried #roforma of enclosure ./..A.

Name of the
$chool
4ear of $tud1 *lace of stud1
>illa-e/(o)n/Cit1
"istrict to )hich
it elon-s







B. a) 'ddress for Corres#ondence )ith
*in Numer
(,rite in Block Letters) :

) 2oile Numer :

c) Land line )ith $(" Code :

d) 5mail ."

C. 'n1 8ther .nformation :
(he information furnished ao0e is true and correct to the est of m1 kno)led-e and if
the information furnished ao0e is found incorrectD . shall e held liale for the conse+uences
thereof:

Place:

Date: Signature o t!e Can"i"ate