Paste a Self- attested
passport size
photograph here
Application Form against Advertisement dated 24th-30th Jan’2015
* POST APPLIED FOR (alongwith specialized area) __________________________________________
Fields marked * are mandatory
1. Personal Details
* Name of the Candidate
: ____________________________
* Father’s / Husband Name
: _________________________
(Full name as appear in Class Xth Certificate)
Gender (Male / Female)
: ____________________________
* Date of Birth (dd/mm/yy)
: _________________________
(Attach copy of Class Xth Certificate with hard copy of Application Form)
* Category
:
_____________________________
(Gen. / SC / ST / OBC / Disabled)
* Whether belong to Minority
(Yes / No)
: _________________________
(Attach copy of Caste Certificate in case belongs to reserved category with hard copy of Application
Form)
* Whether applicant is
: _____________________________
Ex-Serviceman (Yes / No)
Landline No.
: _____________________________
Marital Status
(Single / Married)
: _________________________
Mobile No.
: _________________________
(with STD code)
* E-Mail
* Complete Current
Residential Address
:
:
_____________________________
_____________________________
* Complete Permanent
Residential Address
:
__________________________
__________________________
_____________________________
__________________________
_____________________________
__________________________
_____________________________
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2. Education Qualification (starting from 10th onward):
Examination Passed
Full Degree Name
(for Graduation and onwards)
Name of the Board / University
/ Institute
Year of
Passing
Whether Regular / PartTime / Distance
Percentage
obtained
* 10th
* 12th
* Graduation
(B.A., B.Com, B.Sc etc.)
Post-Graduation
(M.A., M.COM, M.Sc etc.)
Use extra sheets, if required. Attach copies of all mark sheets, certificates duly self-attested with hard copy of Printed Application Form.
3. Professional Qualification:
Full Name of Degree / Course
Name of the University /
Institute
College Name
Duration
of the
Course in
Years
Year of
Passing
Whether
Regular/
Part Time /
Distance
Specialization /
Discipline
Percentage
/ Grade
obtained
Use extra sheets, if required. Attach copies of all mark sheets, certificates duly self-attested with hard copy of Printed Application Form.
4. Additional Qualification/Training attended (if any):
S.No.
Full Name of Qualification / Training
Duration
Details (in brief)
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5. Details of complete experience starting from the present employer:
(only after Graduation Experience has to be mentioned)
S.No.
Name of Employer
Position
held
Executive
or NonExecutive
Duration of Position held
From Date
To Date
Job Profile (in brief)
Gross Salary
p.m.
(in Rs.)
Use extra sheets, if required. Attach copies of all experience certificates duly self-attested with hard copy of Printed Application Form.
6. If presently working with Government / Semi-Govternment / PSUs/Banks / Local Bodies etc., please give Name & Address of HR
Head / Personnel Department.
Name & Address of the HR Head / Personnel Deptt. : ________________________________________________________
_________________________________________________________
7. Have you ever appeared in interview for any post in NSIC during last 3 years?
:
Yes _____ / No _____
In case Yes, provide the following details:
Name of the post : ________________________ Year of interview : ________________________
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8. References with complete Name, Address, Telephone, Mobile Numbers:
(1) Reference No.1:________________________________
(2) Reference No.2:________________________________
________________________________
________________________________
________________________________
________________________________
Place: ____________________________________
Date: ______________
Self-Declaration of applicant:
(a)
I have verified the above details, and the details are in order to the best of my knowledge & belief.
(b)
I understand that merely filling this Application Form will not be treated a complete application. Therefore, I further declare that I will send this
Yes Application Form with self-attested photo pasted at appropriate place, copies of all self-attested certificates of caste/disability/work experiences/
qualification to DGM(HR), NSIC Ltd. so that the same is received on or before 17.02.2015.
Signature of Applicant
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