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FORMAT FOR APPLICATIONRecentpassport sizephoto dulyattested byGazettedOfficer1 Name in full (Block letters) :2 Name of Father/Mother/Spouse :3 Age (No. of years completed):(Copy of Date of Birth Certificate to beenclosed)4 Gender : Male / Female5 Educational Qualifications:(Please write details of qualifications)Copies of educational qualificationcertificates to be enclosed6 Experience of working on People’s issues (Copies of experience certificates are tobe enclosed)Sl.NoName of theDept./Agency/NGODesignationPeriod of work(Specify datesbelow)From ToMajorresponsibilities9 Address <strong>for</strong> communication(Please give full postal address with PINcode, Phone Number, E-mail ID & MobileNumber etc.):Signature of Candidate* All copies of certificates mentioned above shall be attested by GazettedOfficer with Seal.

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