proforma of application for contract appointment - High Court of ...

PROFORMA OF APPLICATION FOR CONTRACT APPOINTMENT

1. Post applied for

: ………………………………………

2. Name of applicant (in BLOCK letters)

: ………………………………………

3. Father's/Husband’s Name

: …………………………..…………

4. Date of Birth

: ………………………………………

Affix recent passport size photograph duly attested by a Gazetted Officer

5. Age as on 01/01/2014 Y

6. Sex (mention code 1 for Male and 2 for Female)

M

7. Whether, bonafide resident of Chhattisgarh (If yes, enclose the attested copy of domicile certificate issued by the competent authority.)

D

Yes

/ No

8. Qualification including Typing & Shorthand : Sl. No.

Name of Exam.

Board/ University

9. Experience (if any)

Year of passing

Division, %, speed of Typing & Shorthand

Subject

: ………………………………………

10. Whether : (please tick whichever is applicable ) SC

ST

OBC

UNRESERVED

11. In case of OBC state whether belongs to creamy layer – 12. Postal address

13. Permanent address

14. Phone/Mobile no. (if any)

Yes / No.

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

15. Whether, Physically Disabled :………………………………….………………… If Yes, mention type and percentage of disability :……………………………… 16. Whether registration no. of employment exchange is in existence :……………….………………… (if Yes mention No. with date) 17. Name of employment office

:………………………………….

18. Whether, the candidate is serving in govt./semi govt. organization (If yes, application must be sent through proper channel)

: Yes / No

19. Whether, the candidate is of sound mind and body and free from any bodily or mental defect which renders him / her unfit for such appointment.

- Yes / No

20. Whether, he/she is having more than one living spouse.

- Yes / No

21. Whether, he/she has been dismissed or removed from service by any High Court, Government or Statutory or Local Authority.

- Yes / No

22. Whether, he/she has been convicted of any offence involving moral turpitude or has been permanently debarred or disqualified by any High Court/ Union/State Public Service Commission or any Services Selection Board or Staff Selection Commission

- Yes / No

23. List of enclosures :1. ……………………………. 3. ……………………………. 5. …………………………….

2. ……………………………. 4. ……………………………. DECLARATION

I do hereby declare that the statements made in this application are true, complete and correct to the best of my knowledge and belief. In the event of any information being found false or incorrect:- (1) before or after test / interview / selection / appointment to the said post my candidature / appointment will be liable to be cancelled/ (2) after joining services to the said post my service shall be liable to be terminated. Place : Date:

(Signature of Applicant)