Annexure-1-Application Form
1
Application for Recruitment in Pay Band-1 of Rs.5200- 20200 – Grade Pay Rs.1800 in South Central Railway Annexure -1 Railway Recruitment Cell / South Central Railway Employment Notice Number – RRC/SCR/GroupD/1/2010 For Office use only: Control Number: Roll Number : 1. Category / Post applied for: (Indicate your order of priority / choice in the box below). You will be considered for the posts applied only. Option / preference Category Number Name of the Post Option / preference Category Number Name of the Post 1. 4. 2. 5. 3. 6. 2. Name of Candidate : 3. Father’s name: 5. Community: ( Tick ): SC ST OB UR 6.Are you Physically Disabled: VH HH OH 7. Address for communication: 8. Nationality 9. Religion P I N C O D E - 10. SEX 12. Nearest railway Station: ( In English only for issue of free railway pass for SC /ST candidates) 11. Marital Status 13. Visible Marks of Identification : ( moles etc on your body) 1. 2. 14. Do you seek age relaxation under any of the category mentioned below? ( Tick appropriate box) SC ST OB Physically Disabled Course Completed Act Apprentice Judicially separated / divorced woman / widow Ex-Servicemen Railway Employee 15. Educational Qualifications: Qualification University / Board Year of passing % of marks SSC / 10 th class ITI Others 16. List of Documents enclosed: (fill in the details of the copies of certificates / documents enclosed.) i) iii) v) ii) iv) vi) 17. Details of IPO /Demand Draft enclosed with the application: 18. Choice of Language for written examination: Name of the Post office / Bank Serial Number & Date Amount 19. Declaration by the candidate: (copy the passage in the box below in your own hand writing): I hereby declare that all the particulars given above by me are true and to the best of my knowledge. I am aware that in the event of any information furnished by me is found false / incorrect at any stage, my candidature will be rejected summarily and I am also liable for criminal action. I will abide by the instructions given in the notification. 4.Date of Birth: ( DD/MM/YYYY): Place: Date: Left hand Thumb Impression Signature of the applicant Paste (do not pin or staple) here your recent colour passport size photo (The photograph shall not be more than 3 months old.) Signature of the candidate
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Transcript of Annexure-1-Application Form
Application for Recruitment in Pay Band-1 of Rs.5200- 20200 – Grade Pay Rs.1800 in South Central Railway Annexure -1
Railway Recruitment Cell / South Central Railway
Employment Notice Number – RRC/SCR/GroupD/1/2010
For Office use only:
Control Number:
Roll Number :
1. Category / Post applied for: (Indicate your order of priority / choice in the box below).
You will be considered for the posts applied only. Option /
preference
Category
Number
Name of the Post Option /
preference
Category
Number
Name of the Post
1. 4.
2. 5.
3. 6.
2. Name of Candidate :
3. Father’s name:
5. Community: ( Tick � ): SC ST OB UR 6.Are you Physically Disabled: VH HH OH
7. Address for communication:
8. Nationality
9. Religion
P I N C O D E - 10. SEX
12. Nearest railway Station: ( In English only for issue of free
railway pass for SC /ST candidates) 11. Marital Status
13. Visible Marks of Identification :
( moles etc on your body)
1.
2.
14. Do you seek age relaxation under any of the category mentioned below? ( Tick ���� appropriate box) SC ST OB Physically Disabled Course Completed
Act Apprentice
Judicially separated /
divorced woman / widow
Ex-Servicemen Railway
Employee
15. Educational Qualifications:
Qualification University / Board Year of passing % of
marks
SSC / 10th
class
ITI
Others
16. List of Documents enclosed: (fill in the details of the copies of certificates / documents enclosed.)
i) iii) v)
ii) iv) vi)
17. Details of IPO /Demand Draft enclosed with the application: 18. Choice of Language for written examination: Name of the Post office / Bank Serial Number & Date Amount
19. Declaration by the candidate: (copy the passage in the box below in your own hand writing): I hereby declare that all the particulars given above by me are true and to the best of my knowledge. I am aware that in the event of any information
furnished by me is found false / incorrect at any stage, my candidature will be rejected summarily and I am also liable for criminal action. I will abide
by the instructions given in the notification.
4.Date of Birth: ( DD/MM/YYYY):
Place:
Date:
Left hand Thumb Impression
Signature of the applicant
Paste (do not pin or
staple) here your recent
colour passport size photo
(The photograph shall not
be more than 3 months
old.)
Signature of the candidate
