Application for Recruitment in Pay Band-1 (Rs.5200- 20200) + Grade Pay Rs.1800 in Northern Railway Annexure -1

Railway Recruitment Cell / Northern RailwayEmployment Notice Number – 220-E/Open Mkt./RRC/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: Sh.

5. Community: ( Tick ): SC S

TOB

UR

6.Are you Physically Disabled:

VH HH

OH

7. Address for communication: 8. Nationality

9. Religion

PIN P H O N E 10. SEX12. 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 ApprenticeJudicially separated / divorced woman / widow

Railway Employee

15. Educational Qualifications: Qualification University / Board Year of passing % of

marksSSC / 10th classITIOthers

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):

Age:

Y Y M M D D

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

Place:

Date: Left hand Thumb Impression Signature of the applicant