Note : All answers must be given in words and not by dashes and dots
No columns should be left blank
All dates should be in DD/MM/YYYY format

1) Name in Block letters:
Max 200 Chars
2) Address

Present Address

Permemant Address

Address 150 Chars 150 Chars
City Max 50 Chars Max 50 Chars
State
Pin code
3) Contact
Email ID Contact No Mobile No
 
4)
Date of Birth (in Christian era): 5) Gender
6)
Marital Status 7) Religion
8)
Whether belongs to SC/ST/OBC If Yes, Specify
9)
Are you Physically Handicapped If Yes, Percentage of disability
10) Date of entry into Govt. service and date of retirement:
11)

Educational Qualifications:

Examination or Degree obtained Class or Division Subject taken Date of Passing Grade / Percentage
12)
Whether Educational and other Qualifications for the post are satisfied. (If any qualification has been treated as equivalent to the one prescribed in the rules, state the authority for the same)
13)
Qualifications/ Experience Qualifications, Experience possessed by the officer
Essential (1) Max 50 Chars Max 50 Chars
Essential (2) Max 50 Chars Max 50 Chars
Essential (3) Max 50 Chars Max 50 Chars
Desirable (1) Max 50 Chars Max 50 Chars
Desirable (2) Max 50 Chars Max 50 Chars
14)
Please state clearly whether in the light of entries made by you above, you meet the requirements of the post
100 Chars
15)
Details of employment in chronological order. Enclose a separate sheet, duly authenticated by your signature, if the space below is insufficient:
Office / instt../Orgn Post held From To Scale of pay/ Pay Band Nature of appointment i.e., whether regular/ adhoc/ deputation Nature of duties
a
b
c
d
16)
Name of the post held substantively, if any, and the scale of pay thereof
100 Chars
17)
Present pay and date from which it is drawn (scale in which drawn also to be indicated)
100 Chars
18)
Additional details about present employment Please state whether working under:
100 Chars
19)
Additional Information, if any, which you would like to mention in support of your suitability for the post. Enclose a separate sheet, if the space is insufficient.
100 Chars
20)
Whether the officer satisfied all the conditions: Prescribed for the post viz,.. qualification, experience and service in analogous posts.
100 Chars
21) Remarks, if any 100 Chars
22)
Date Place