3/5/2015 Registration Slip

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FOOD CORPORATION OF INDIA

ZONE-WISE RECRUITMENT forJunior Engineer (JE) (Civil Engineering / Electrical Engineering / Mechanical Engineering),

Assistant Grade-II (Hindi), Typist (Hindi) and Assistant Grade-III (General / Accounts / Technical / Depot)

Registered Application Form

Application Form for the Post of : Assistant Grade III (Accounts) ( G ) SOUTH ZONE

Registration Number : 27220038639

1. Candidate's Name : NANJAPPA M (Name as recorded in the Matriculation / Secondary Examination Certificate)

22.Photo

2. (a) Father's Name : MARAPPA

(b) Mother's Name : SUBBAMMA

3. Gender : MALE

4. Date of Birth : (As recorded in the Matriculation / Secondary Examination Certificate.)

06/07/1986 5. Age : 28 Year(s), 5 Month(s), 26 Day(s) as on (01.01.2015)

6. Category : OBC 23.Signature

7. Whether Domiciled in the Kashmir Division in the State of Jammu andKashmir during the period 01-01-1980 to 31-12-1989:

NO

8. Whether Ex-Servicemen / Availed the benefits of Ex-Servicemen: NO

9. Whether Person with Disabilities(PWD)/ Physically Handicapped(PH): NO

10. Whether Departmental (FCI) Employee: NO

11. Whether belonging to Minority Community: NO

12. Nationality : indian

13. Zone Applied For : SOUTH

14. Name of the Written Test Center: Bangalore

15. Post Applied For : Assistant Grade III (Accounts) ( G )

16.Educational Qualification

(a) Name of Academic/Professional Degree/ Diploma(which makes you eligible):

Bachelor of Commerce from a recognized University

Do you have : Proficiency in use of Computers YES

(b) Name of the University /Board:

bangalore (Whether Recognized University/ an Institution approved by AICTE or Board) : YES

(c) Year of Passing 2009 (Year)

(d) Duration of Course /Programme :

36 (in Months)

(e) Percentage of Marks : 65.42 %(Marks up to 2 decimal points in aggregate of all years/ semesters (In case of CGPA / OGPA / Letter Grades, it isequivalent percentage(%).

(f) Remarks if any :

17. Whether completed : YES

18 (a). Email Id : nanjappambabu65@gmail.com

(b). Confirm Email id: nanjappambabu65@gmail.com

19. Mobile Number : 7411303805

ADVERTISEMENT NO. 3/ 2015 FCI CATEGORY - III

https://fcijobsportal.com/fci2014/pages/index2014.aspx

3/5/2015 Registration Slip

https://fcijobsportal.com/AGIII2014/pages/RegSlip.aspx 2/2

(Please Print the form for Further Reference)

20. Experience : YES - Total Experience : 31 ( in Months )

Details of Work Experience (starting from latest employment)

Name andAddress of

theEmployer(s)

Type of Organisation

(Cent.Gov t./ State Gov t./

Cent.Gov t. PSU/

State Gov t.PSU/Others)

Designation Nature OfDuties

Period of Service Length ofservice

(in Months)

Basic Scale ofPay & TotalEmoluments

(per Month)

Type of Scale(IDA/ CDA.If others,equiv alent scale in

IDA/ CDA)

Remarks(if any)

From (DD/MM/YYYY)

To (DD/MM/YYYY)

swamy v ivekananda rural pu college

others lecturer teaching 01/06/2012 31/01/2015 31 200000 consolidate

21. Communication Address :

(a). Address Line 1: SHIVANAPURA V , CHIKKATIRUPATI POST

(6). Address Line 2: HOSAKOTE TQ,

(c). City: BANGALORE

(d). District: BANGALORE RURAL

(e). Pin Code: 563130

(f). State: Karnataka

24. Whether FEE Paid : YES - Bank Reference Number : CP15891668 , Deposit Date : 05 Mar 2015 Amount {Excluding bank charges but including service tax of Rs. 39/-. Service Tax Code (Registration Number) AAACF0365NST099} : 350 (in Rs.)

25. Declaration :

i. I have not submitted any other application for this examination. I am aware that if I contravene this rule, my application will be rejected summarily byFCI.

ii. I have read the provisions in the Advertisement carefully and hereby undertake to abide by them.

iii. I further declare that I fulfill all the conditions of eligibility regarding age limits, educational qualifications, experience etc. prescribed for the post appliedfor.

iv. I also declare that I do not stand debarred by FCI as on date and have never been convicted by any court of law. I also declare that no charge sheet ispending against me in any court of law. Further declare that I have never been dismissed or compulsorily retired from the service of the Corporation orfrom a Department of a State or the Central Government or from any Public Sector Undertaking or my service been terminated during probation.

v. For Candidate belonging to OBC -I declare that I belong to the community, which is recognized as backward class by the Govt. of India for the purpose of reservation in services as perorder contained in Deptt. of Personnel and Training Office Memorandum No. 36012/ 22/ 93-Estt.(SCT) dated 8.9.1993. I also declare that I do notbelong to the person / sections (creamy layer) mentioned in column 3 of the schedule of the OM mentioned above and modified vide Govt. of IndiaDOPT OMs mentioned in the Notice. I further declare that I am in possession of OBC Certificate in the prescribed format given in the Notice of theAdvertisement.

vi. I hereby declare that there is no Vigilance / Disciplinary case pending against me. I am in possession of No Objection Certificate from my employerwhich shall be required to be sent along with other essential enclosures in case of my shortlisting on the basis of the Written Test / Skill test at thedesignated Address which shall be informed / notified through the designated website (www.fcijobsportal.com)

vii. I hereby declare that self-certified copies of relevant certificates / documents are in my possession. In case, self-certified copies of the relevantcertificates / documents are not provided by me along with the Registered Online Application Form Printout, if called for, my candidature will becancelled without any notice.

I hereby declare that all the information given/ statements made by me in the application are true, complete and correct to the best of myknowledge and belief and nothing has been concealed or suppressed. In the event of any information being found false or incorrect or is not inconformity with the eligibility criteria mentioned in the advertisement at any point of time my candidature / appointment may be cancelled / terminatedwithout any notice and / or I shall be liable for any other action under the extant rules.

Date: 05 Mar 2015 Signature:

Place: Candidate's Name (in Capital letters):