colour glasses. 1.Name of the candidate. ( Name in CAPITAL letters as
appearing in SSLC Certificate ). 4.Address for Correspondence(write in CAPITAL
letters).
For Office Use
Railway Recruitment Cell South Western Railway, Hubli Application Form for posts in PB-I Grade Pay-Rs.1800/-(erstwhile Group 'D') in SWR (Read the guidelines carefully, before you start filling up the Application Form) Employment Notification No.01/2012 1.Name of the candidate ( Name in CAPITAL letters as appearing in SSLC Certificate )
2. Father's/Husband's Name 3.Nearest Railway Station 4.Address for Correspondence(write in CAPITAL letters)
5.Sex Please paste(not older than one month) recent Passport size (4.5 X 3.5cm) Photograph Without cap & colour glasses
6.Nationality 7.Religion 8.Marital status State:
PIN Code
Contact Phone Number with STD code 9.Date of Birth:
13. Tick(√) the appropriate column, if applicable (Enclose copy of certificate in support of claim) Widow/ Divorced/ Economically Judicially separated weaker section women
Persons with Disabilities VH
HH
Central/ State Govt. Employees
Serving Employee
Staff of Quasi Administrative office of Railways
Residents of Jammu & Kashmir
OH
14.Personal marks of Identification
1.
(Scars, moles,or another permanent marks on the body )
2.
15.Details of IPO:
No:
Dt:
Amount:
Name of the Post Office & place 16.List of enclosures
1.
3.
2.
4.
17.DELCARATION BY THE CANDIDATE(Please write the below paragraph in the space given in your own handwriting) I hereby declare that all the particulars given above by me are true, complete and correct to the best of my knowledge and belief. In the event of any information furnished by me being found false/incorrect, my candidature is liable to be rejected/terminated summarily.
Left Hand Thumb impression(Must be clear and not smudged) Place:
Date:
1
2
Signature of the Candiate (Do not sign in the capital letters)
