Application Format To: The Executive Officer, Purulia Zilla Parishad Sub: Application for the contractual post of Support Staff (Office Management) under CHCMI, PZP Sir, As per advertisement no.‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐dated‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐, I am to submit herewith the application for the above post for necessary action. The details are given below with attested enclosure. Affix recent pass photograph duly signed by the candidate 1) Name of the Candidate[in capital letter]: 2) Father’s Name: 3) Date of Birth: 4) Age as on 31.03.2014: 5) Parmanent Address [with PIN No.] 6) Address for Communication[with PIN] 7) DND deactivated Mobile No. 8) Qualification: Name Exam of the Name of the Board Higher Secondary Year of passing Total marks % of marks obtained 9) Working Experience: 10) Compter Knowledge: [Pls attach attested copy of Admit Card of Madhayamik, Marksheet of H.S, Certificate of working experience and Certificate on computer knowledge from recognized authority and one identical pass post size photo of the candidate] I do hereby certify that all the documents and information furnised above are best of my knowledge and believe. If any document(s)/information is found false, my candidature will be rejected at any point of time by the office. [Full signature of the candidate] Date:
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