Assam Gazette (Part -Ix) Standard Form Of Application printable pdf download

ASSAM GAZETTE (PART -IX)

STANDARD FORM OF APPLICATION

To,

PHOTO

The ………………………………………………………………………………………………………………………

Name of the Post ………………………………………………………………………………………………..

Department/Office ……………………………………………………………………………………………..

1. Name in Full (Block letter)

: …………………………………………………………..………………………………..

2. Present Address

: ……………………………………………Vill/Town………………………………..

…………………………………………………………………………………………….

3. Permanent Address

: …………………………………………… Vill/Town……………………………….

……………………………………………………………………………………………..

4. Father’s Name & Address

: …………………………………………………………………………………………….

5. Place of birth including Police Station and

: …………………………………………………………………………………………….

District & P.O

…………………………………………………………………………………………….

6. Are you a citizen of india and if so how? (Copy of citizenship certificate should be enclosed

where necessary )

: …………………………………………………………………………………………….

7. Educational qualification and also the

: …………………………………………………………………………………………….

name and full address

…………………………………………………………………………………………….

8. Other Qualifications

: …………………………………………………………………………………………….

9. Community

: …………………………………………………………………………………………….

(a) State your religion

: ……………………………………………………………………………………………

(b) Are you a member of Schedule

: ……………………………………………………………………………………………

Caste/Schedule Tribe

(Answer ‘Yes’ or ‘No’) If ‘Yes’ give particulars supported by a certificate copy of which should be enclosed.

10. Age on the 1

January 20…. (According to H.S.L.C certificate copy of which should be enclosed)

: …………………………………………………………………………………………..

11. Present occupation (if any)

: …………………………………………………………………………………………..

12. Previous appointment held (if any)

: …………………………………………………………………………………………..

13. Are you a temporary or retrenched personal of Temporary Departmental of the Govt. of Assam

(Answer ‘Yes’ or ‘No’) State particulars

: …………………………………………………………………………………………..

14. Are you trained in or a member of the National Cade Crops of Territorial Army or trained Home Guards and

Civil Defence Volunteers, if so give particulars.

: ………………………………………………………………………………………….

15. Employment Registration No.

: ………………………………………………………………………………………….

16. Whether there is any Govt./Semi Govt. Employees in your family if any, Particulars of such family member like

relationship, name of the job, pay drawn, place of posting, permanent /Temporary etc. should be furnished.

: …………………………………………………………………………………………

………………………………………………………………………………………….

17. Family’s income certificate from the

: ………………………………………………………………………………………….

Gaon Panchayat /DC/SDO/Circle Officer to be furnished

18. Examination Centre

: ………………………………………………………………………………………….

I am a candidate for the post ……………………………………………….. and the stated above are true to the best of my

knowledge and behalf. In case of any false statement, I am liable to any action the Government deem fit and

proper.

A treasury challan of Rs ……………………… is attached herewith.

19. To be filled in by Candidate

Date: …………………………………

Place: ………………………………..

Signature of Candidate

Assam Gazette (Part -Ix) Standard Form Of Application

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