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Application form

Part A

for the post of 

Task Manager (On Contract) 

1. Name of the post (Applied for) : …………………………………………………

2. Post code no. : 2 (Two)

  (i.e. s.no. of post in advertisement)

3. Name of applicant :. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(Name) (Srname)

!. "ather#s name : ………………………………………………………………(Name) (Srname)

$. Permanent address : ………………………………………………………………

  ………………………………………………P%N………….

&. Present address : ………………………………………………………………

  ………………………………………………P%N………….:.

(Address proof : 'nclosre

. ate of *irth :. . . . +. . ..+ . . . . . . . (%n words …….. . . . . . . . . . . . . . . . . . . . .)

(Attested tre cop, of mar-sheet of i/her Secondar, School 0ertificate 'amination +eivalen

eamination ehi*itin/ date of *irth : 'nclosre 2)

. A/e as on 41+12+241$ : …………… 5ears ………… 6onths …………. a,s

7. 0ate/or, (Please tic-) : Unreserved/ OBC/ SC/ ST

  (Attested tre cop, of caste certificate in case of 890+S0+ST candidate : 'nclosre …..)

14. ome district : ………………………………………………………………

11. 'dcational alification details :

(1) Post radation : e/ree . . . . . .. .. . Specialisation in ……………………….

(2) radation : e/ree . . .. . . .. . . .S*;ect …………………………………

(3) 8thers : escription ……… . .. . .. . . . . . . . . . . .…………………….

12. Service and eperience details :

(1) Parent epartment :

……………………………………………………………….

1

<ecent colored

P.P. si=e photo/raph attested *,

a=atted 8fficer

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(2) etails of or/anisation : ……………………………………………………………….

(3) Present Post :. …………………………………………………………….

(!) Present place of postin/ :. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . .

($) esi/nation at first postin/ :. . .. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. .

(&) Present pa, scale :. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ……….

(As per present applica*le pa, rles)

(e./. pa, scale and /rade pa, in revised pa, strctre)

() Present *asic pa, :. <s. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. .

  (e./. pa, in pa, *and > /rade pa, in revised pa, strctre)

() 'perience on present post (as on 41+11+241$) :. . . . . . 5ears . . . . .6onths . . . . . a,s.

(7) "ield eperience on present post (as on 41+11+241$) :. . . 5ears . . . . .6onths . . . a,s.

(14) Total len/th of service (as on 41+11+241$) :. . . . . . ..5ears . . . . .6onths . . . . . a,s.

13. PAN (if availa*le) : ……………………………………..

  (Attested tre cop, : 'nclosre . . . .)

1!. 0ell phone no. : ……………………………………..

  (Si/natre of applicant)

 Name of the applicant: . . . . . . .. . . . . . . . . . . . . . .

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 Declaration

% here*, declare that no criminal proceedin/s of an, natre is pendin/ consideration a/ain

me. % frther declare that information spplied *, me in? the application form and its spplementar, par

and enclosres anneed to it@ are tre to the *est of m, -nowled/e *elief. 6, selection to the post ma

 *e cancelled and sita*le action ma, *e ta-en? if information frnished *, me shall *e fond false

incorrect at an, point of time in ftre.

  (Si/natre)

 Name of the applicant: . . . . . . .. . . . . . . . . . . . . . .

'ncl B Part 9?0 and of the applicationalon/ with enclosre 1 to ……….

ate :. . . . . . .. .

Place :. . . . . . .. .

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Part B

Post Task Manager (On Contract)

1. Name of the post (Applied for) : ……………………………………………………………….

2. Post code no. : 2 (Two)

  (i.e. s.no. of post in advertisement)

3. Name of applicant :. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . .. .(Name) (Srname)

!. "ather#s name : ………………………………………………………………(Name) (Srname)

$. Present address : ………………………………………………………………

  ………………………………………………P%N………….:.

(Address proof : 'nclosre

&. ate of *irth :. . . . +. . ..+ . . . . . . . (%n words …….. . . . . . . . . . . . . . . . . . . . .)

(Attested tre cop, of mar-sheet of i/her Secondar, School 0ertificate 'amination +eivalen

eamination ehi*itin/ date of *irth : 'nclosre 2)

. A/e as on 41+12+241$ : …………… 5ears ………… 6onths …………. a,s

. 0ate/or, (Please tic-) : Cnreserved + 890 + S0 + ST

  (Attested tre cop, of caste certificate in case of 890+S0+ST candidate : 'nclosre …..)

7. ome district : ………………………………………………………………

14. PAN (if availa*le) : ………………….

  (Attested tre cop, : 'nclosre . . . .)

(Si/natre of applicant)

 Name of the applicant: . . . . . . .. . . . . . . . . . . . . . .

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Part C

Post Task Manager (On Contract)

1. Name of the post (Applied for) : ………………………………………………………………

2. Post code no. : 2 (Two)  (i.e. s.no. of post in advertisement)

3. Name of applicant :. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .. .(Name) (Srname)

!. "ather#s name : ………………………………………………………………(Name) (Srname)

$. 'dcational alification details :

(1) Post radation : (i) e/ree . .. . .. . .. . . Specialisation in ……………

  : (ii) Name of instittion

: (iii) 5ear of passin/

: (iv) Percenta/e of mar-s+0PA

('nclosre…….)

(2) radation : (i) e/ree . .. . . .. . . .. 9ranch ………………………

  : (ii) Name of instittion

: (iii) 5ear of passin/

: (iv) Percenta/e of mar-s+0PA

('nclosre…….) (3) 8thers : (i) escription …………………………

  : (ii) Name of instittion

: (iii) 5ear of passin/

: (iv) Percenta/e of mar-s+0PA

('nclosre…....)

  (Si/natre of applicant)

 Name of the applicant: . . . . . . .. . . . . . . . . . . . . . .

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