Name of Block Name of Block Name of Block AUL BADACHANA ... - Tcil

TELECOMMUNICATIONS CONSULTANTS INDIA LTD. (A Govt. of India Enterprises) IS/ISO 9001 2008

APPLICATION FORMAT FOR RECRUITMENT (ONE FORM FOR ONE POST ONLY) PASTE RECENT

1.

Post Applied For

:

PASSPORT SIZE

SCHOOL COORDINATOR

PHOTOGRAPH

2.

Preferred District (Please tick Any One): KENDRAPADA JAJPUR JAGATSINGHPUR

3.

Preferred Block (Please tick Any Three within the preferred district):

DISTRICTKENDRAPADA

Name of Block AUL DERABISH GARADAPUR KENDRAPADA MAHAKALPADA MARSHAGHAI PATTAMUNDAI RAJAKANIKA RAJNAGAR

Date

DISTRICTJAJPUR

Name of Block BADACHANA BARI BINJHARPUR DANAGADI DASARATHPUR DHARMASALA JAJPUR KORAI RASULPUR SUKINDA VYASANAGAR

DISTRICTJAGATSINGHPUR

Name of Block BALIKUDA BIRIDI CUTTACK PRT ERASAMA JAGATSINGHPUR KUJANG NAUGAON PARADEEP RAGHUNATHPUR TIRTOL (Signature of Candidate)

TELECOMMUNICATIONS CONSULTANTS INDIA LTD. (A Govt. of India Enterprises) IS/ISO 9001 2008

4.

Personal Details a) Name

b) Father’s Name/Husband’s Name

c) Date of Birth

d) Age as on today

e) Sex

f) Marital Status

g) Category (SC/ST/OBC/GEN)

h) Nationality

5.

Address for Correspondence

Permanent Address

Address

Tel. No.*

1.

2.

Mobile No.*

1.

2.

E-Mail*

1.

2.

* Mandatory Fields

(Signature of Candidate) Date

TELECOMMUNICATIONS CONSULTANTS INDIA LTD. (A Govt. of India Enterprises) IS/ISO 9001 2008

6 (a). Sl.

Academic Qualifications in descending order Examination Passed

No.

6 (b). Sl. No.

6 (c). Sl. No.

Date

Name of

Year of Passing

% of Marks/

Specialization

Grade

Institution/University

Professional Qualifications Examination Passed

Name of Institution/University

Year of Passing

% of Marks/ Grade

Specialization

Certification (if any) Course/ Certification

Field

Name of Institution/University

Year of Passing

(Signature of Candidate)

TELECOMMUNICATIONS CONSULTANTS INDIA LTD. (A Govt. of India Enterprises) IS/ISO 9001 2008

7

Employment Records 7 (a) Current Employment Record

Sr. No.

Organization

7 (b) Sr. No.

Date

Past Experience Organization

Designation

Designation

Salary

Period From To (dd/mm/yyyy (dd/mm/yyyy)

Job Description

Salary

Period

Job Description

From (dd/mm/yyyy

To (dd/mm/yyyy)

(Signature of Candidate)

TELECOMMUNICATIONS CONSULTANTS INDIA LTD. (A Govt. of India Enterprises) IS/ISO 9001 2008

8.

Total Post Qualification Experience in years :

9.

Any other information relevant to the job :

Note : 1. If the sheets above are not sufficient please attach extra sheets, wherever necessary. 2. Mentioned the list of documents attached alongwith the form. (a)……………………… (b)……………………… (c)………………………. Declaration I _______________________________________ Son / Daughter of Shri _______________________________________ Age____________ Year ______________________ resident of ___________________________________________________________ District _____________________ Odisha, hereby declare that the information given above and in the enclosed documents is true to the best of my knowledge and belief and nothing has been concealed therein. I am well aware of the fact that if the information given by me is proved false/not true, I will have to face the punishment as per the law. Also, all the benefits availed by me shall be summarily withdrawn.

Date

(Signature of Candidate)