Mini Ratna Psu_ Application Form 2

1/1/14 MINI RATNA PSU: APPLICATION FORM

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Mini Ratna PSU 2013Application Form for Post Code: 04

* Application No.

*324625*

* Application for the Post of Jr. Technical Assistant (Post Code: 04)

* Test CentreChoice1: LUCKNOW Choice2: PATNA

*Language in which you wantto take the Written Test:ENGLISH

Personal Particulars

* Candidate Name Mr. MANOJ KUMAR BHARATI * Father's Name CHHOTE LAL RAM

* Address for Communication VILL-PHEPHANA POST-PHEPHANA

DISTT.-BALLIA

* City BALLIA * Pin Code 277503

State UTTAR PRADESH

* Email-ID [email protected] Alternate Email-ID [email protected]

Contact No. - Mobile No. 7309092675

* Date of Birth 07-Jul-1989

* Gender Male * Category SC

*

Whether Kashmiri Migrant?(Are you ordinarily been domiciled in the Kashmir Division ofthe State of Jammu and Kashmir during the period 01-01-1980 to 31-12-1989?)

NO

*Are you Departmentalemployee of theorganisation?

NO if yes, specify Month & Yearof superannuation date

-

*Are you a person withDisabilities?

NO

If yes, Nature of Disability &Degree

Whether Guide/Scribe isrequired at the ExaminationCentre?

.................................. Signature of Candidate



Application No.: 324625

*324625*

Qualification Detail

Academic/ProfessionalQualification

Discipline/Specialization

University/Board Main SubjectsYear ofPassing

Percentage Division

Matric - CBSEHINDI,ENGLISH,MATHS,SOCIALSCIENCE,SCIENCE,

2004 71.00 FIRST

12th SCIENCE(BIOLOGY) CBSE HINDI,ENGLISH,BIOLOGY,PHYSICS,CHEMISTRY 2006 70.40 FIRST

GraduationDegree Name:DEGREE INAGRICULTURE

AGRICULTURE BHU AGRICULTURE 2013 81.30 FIRST

Professional/PGDegree Name:

Any OtherQualification:

Experience Details(Backwards from Present Position)

Name and Address of the Employer Position Held

Period of Employment

Remarks, if anyFrom(MM-YYYY)

To(MM-YYYY)

- -

- -

- -

Demand Draft Details (Not Applicable for SC/ST & PH Candidates)

* DD No. * DD Date --

* DD Amount 0/- * Issuing Bank's Name

Declaration

I hereby declare that all statements made in the application are true, complete and correct to the best of my knowledge and belief. In theevent of any information being found false or incorrect at any point of time, my candidature/appointment may be cancelled/terminated withoutany notice. I also declare that I am a citizen of India by birth/domicile.

Place

Date Signature of Applicant

(To be signed prior to despatch)

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Print

(Please Print the form for Further Reference)

CERITIFICATE FROM THE PRESENT EMPLOYER (Wherever applicable) (For candidates serving in Central Govt./State Govt./Public sector Undertaking/Autonomous bodies)

Certified that the above mentioned information furnished by the officer is true and there is no Vig./Disp. Case pending againsthim/her.

(Signature & Seal of Employer)

.................................. Signature of Candidate



Important Instruction for Candidates:

1. Attach your two passport size photograph (without attestation) in the space provided.2. Endorse your signatures in the space provided.3. Application form received without two photographs, signatures, Self attested documents viz. Qualification, Experience,

Age, Caste etc. will be rejected.4. Send the duly completed application form in single envelope superscribing "Application for the post (name of the post

& Post Code No.) Category:________" should reach by 18 January 2014 to:

Post Box No. 4334, Kalkaji Head Post Office, New Delhi-110019

5. The applications received after the closing date will not be entertained6. Self attested Photostat copies of documents in proof of Age; Qualifications (including all mark sheets clearly

indicating the division of passing/%age of marks & specialization certificate in case of MBA), Caste etc. shouldbe attached with the printout of Application Form having auto generated Application Number. Application /Copy of the Registration Slip Original certificates will, however, be scrutinized / verified at the time ofinterview.

Application No.: 324625

*324625*

Name: MANOJ KUMAR BHARATIAddress: VILL-PHEPHANAPOST-PHEPHANADISTT.-BALLIA

BALLIA-277503UTTAR PRADESH

Test Date: 02 March 2014 (Tentative)

Signature of Applicant(in the space provided)



Please Cut & Affix the Address Label given below on the envelop for sending Application/ Registration Slip(print version ofOnline Application Form) and relevant Self Attested copies of certificates/testimonials

------------------------------------- --------------------------

Application for Mini Ratna PSU 2013

Post Applied: 04-Jr. Technical Assistant Category: SC

To

Post Box No. 4334, Kalkaji Head Post Office, New Delhi-110019

------------------------------------- --------------------------

Documents

Mini Ratna Psu_ Application Form 2