(To be filled in by the candidate in Hindi / English in his / her own handwriting)
To,
The Chief Administrative Officer & Head of Office,Indian Bureau of Mines (IBM),
4th Floor, Indira Bhavan,
Civil Lines, Nagpur-440001.
1. Post applied for
2. Name of Employment Exchange with Registration No.
3. Name in Block Letters
4. Father’s/Husband’s Name
5. Present Address in full
6. Nationality & Religion
7. Whether belongs to SC/ST/OBC/Ex-Serviceman
8. (a) Date of Birth
(b) Age as on the closing date for submission of application
Years Months Days
9. Educational Qualifications:
10. Experience
11. Whether Ex-Serviceman, if yes, total length of military service: Years Months
12. Nearest Railway Station from residence
13. Any other information
14. Whether prepared to be posted to any of the Regional Offices / Headquarter of IBM
15. Declaration: I do hereby declare that all the statements made in this application are true, complete and correct to the best of my knowledge and belief. I understand and agree that in the event of any of the particulars or information given herein being found false or incorrect / incomplete or ineligibility being detected at any time before or after selection/ interview, my candidature is liable to be rejected or cancelled and in the event of any misstatement / discrepancy in the particulars being detected at any stage or after any appointment my service shall be liable to be terminated without any notice.
Signature of the Candidate
Place:
Date:
No comments:
Post a Comment