(backlog vacancies) for sc / st junior assistant / typist ... - Srikakulam

LIMITED RECRUITMENT (BACKLOG VACANCIES) FOR S.C / S.T
JUNIOR ASSISTANT / TYPIST / OFFICE SUBORDINATE POSTS
APPLICATION FORM FOR THE POST OF __ __ __ __ __ __ __ __ __ __ __
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Please read the INSTRUCTIONS carefully be<strong>for</strong>e filling the application details
a) This <strong>for</strong>m must be completed by the applicant in his own hand writing and must be
sent with necessary documents to the Collector concerned.
b) Applicant in which any portion of the required in<strong>for</strong>mation is not correctly and
completely given will be summarily rejected.
c) Application which is received after the due date will be summarily rejected.
d) Application in respect of which pre<strong>sc</strong>ribed documents and certificates in proper <strong>for</strong>m
is received after due date will be summarily rejected.
e) Application from persons in the service of the Indian Union of a State in Indian or in
the employ of local bodies whether they are permanent or approved probationers or
probationers or holdings the appointments on temporary or officiating basis which are
not sent through the authority competent to appointment them in the posts which they
are holding will be summarily rejected.
f) Copies of the documents where originals are required to be sent must be certified as
correct by a Gazetted Officer or a Magistrate or other responsible person.
g) Candidates must make arrangements to see that communications addressed to them at
the addresses stated in their applications are redirected, if necessary every ef<strong>for</strong>t will
be made, by the Collector to take account of chances in Candidate’s addresses but
cannot accept any responsibility in this matter.
h) An applicant will be disqualified who attempts to canvas or to bring influence to bear
on the Collector / District Selection Committee personally or by a letter. The same
penalty will be imposed if any relative, friend, patron, official or other persons
attempts to influence the Collector on behalf of the applicant.
i) Necessary certified copies wherever necessary should be enclosed.
contd..2..

PERSONAL INFORMATION:
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01) Name of the Applicant in full :
(Capital Letters)
02) Father / Husband Name :
03) Address in Full :
04) Date of Birth (evidence to produced :
with attested copy of the document)
05) Place of Birth
Village / Town :
District :
State :
06) Native Place
Village / Town
District
State
07) Is the applicant a citizen of India :
08) Does the candidate belong to SC / ST
Category or is he / she parents converted :
to Christianity from any of the SC / ST ?
If so, please specify (evidence to produced
With attested copy of the document)
09) Does the applicant apply <strong>for</strong> appointment?
To more than one service and, if so,
Mention order of Preference
Preference 1
Preference 2
Preference 3
10) Mother Tongue :
11) Other Indian languages known :
Contd..3..

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12) Institutions or Institutions where the applicant was educated with dates from V-Class
onwards
Name of the Institution
with full address
QUALIFICATIONS
Approximate date
of entering
Approximate date
of leaving
Examination
passed
13) Intermediate or its equivalent Examination (Attested Marks Memo / certificate should
enclosed)
Register
Number
Month & Year
of passing of
Examination
Name of the Board
Total Marks
secured
% of Marks
14) Higher educational qualification (Attested Marks Memo / certificate should enclosed)
Register
Number
Month & Year
of passing of
Examination
Name of the University
Total Marks
secured
15) Technical Qualifications: (Attested Marks Memo / certificate should enclosed)
Register
Number
Month & Year
of passing of
Examination
Name of the University
Total Marks
secured
% of Marks
% of Marks
Contd..4..

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16) Has the applicant rendered war service or is
serving with the <strong>for</strong>ces or been invalidated
from the war service ? Give the details
with dates. (Authenticated extract of the
Di<strong>sc</strong>harge Certificate to be produced as evidence)
17) Employment Exchange Registration number
and place or Registration of the applicant.
I declare that I have not at any time been pronounced unfit <strong>for</strong> Government service by
any medical authority and that the particulars given in this application are correct to the best
of my knowledge and belief.
STATION:
DATE:
Signature of the Applicant