APPLICATION FOR THE POSR OF PWD (JE - CIVIL) PUDUCHERRY

1. Name of the Applicant :

2. Post Applied for :

3. Father’s Name :

4. Mother’s Name :

5. Age : Years Months Days

6. Date of Birth :

7. Nationality :

8. Religion :

9. Gender (Male/Female) :

10. Marital Status :

11. Address

For Communication Permanent

State: Pin: State: Pin:

Mobile : Email :
12. Category:
 13. Educational Qualification:

Percentage Year of
SI.No. Examination/Degree Board/University/Institute Subject
of Marks Passing

14. Experience

Name of the Nature of Length of Reason for

SI.No. Post Held
Organization Responsibility Service quitting the job

Declaration
I hereby declare that I have carefully read and understood the instructions and particulars
supplied to me, and that all entries in this form, as well as, in attached sheets are true to the best of my
knowledge and belief. At any stage if any of the information furnished by me is found to be false or incorrect,
suitable action may be taken against me. If selected, I promise to abide by the rules and regulations of the
Pondicherry Government.

Date: Signature of the applicant