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Application Form (Intake) - Special Recruitment Drive For Persons With Disabilities, India Page 3

20.

Are you under any contractual obligation to serve the Central/State government/any other Public Sector

Undertaking/Autonomous Bodies? If so, please furnish full details.

21.

Name, address and phone / mobile Nos. of two persons to whom a reference can be made :-

Phone / Mobile No :

22.

Whether the applicant has ever served in Central or State Government or any other organisation and is in

receipt of any pension, gratuity or employer's share to the Provident Fund ? Details thereof :-

23.

Any other information you may wish to add

DECLARATION

I hereby declare that the above information is factually correct to the best of my knowledge

and belief.

I am aware that my application is liable to be rejected if the information given is incomplete

or found to be incorrect.

I understand that in the event of any information being found false or incorrect at any stage or

not satisfying the eligibility conditions according to the requirements mentioned in the

advertisement, my candidature / appointment is liable to be cancelled / terminated.

I undertake to abide by all the condition specified in the advertisement.

____________________

Place : _________________

Signature of the candidate

Date : __________________

Name______________________

Application Form (Intake) - Special Recruitment Drive For Persons With Disabilities, India Page 3