STANDARD FORM OF APPLICATION (ASSAM GAZETTE PART IX) To The.................. Sub: -Application for the post of Ref: -Your Advertisement Sir In response to your advertisement quoted above on the subject I have the honour to offer myself as a candidate for the same with the particulars furnished in the prescribed form. 1. Name in full (block letters) 2. Present Address 3. Father's Name & Present address 4. Place of birth including Police St. and District 5. Are you a citizen of India if so, how (Copy of Citizenship certificates should be enclosed where Necessary) 6. Educational qualification and also the name & Full address of the education institution (which Read last copies of certificate should be enclosed) 7. Other Qualification 8. Community (a) State your religion (b) Are you Member of SC/ST (Answer 'yes' or 'No' if yes State particular's by a copy of certificate) 9. Age on the 1st. January 200 (according to H.S.L.C. Examination copy of which should be Enclosed) 10. Present occupation, if any 11. Previous appointment held, if any 12. Are you a temporary or retrenched personal of a Temporary Deptt. Of the Govt. of Assam? Answer 'Yes' or 'No' if yes state Particulars 13. Re you trained in a member of the N.C.C.or Territorial Army, or trained Home Guards and Civil defence volunteer's if so, give particulars 14. Name of Employment Exchange & Regd. No 15. The Name of the Assembly or Constitution I am a candidate for the post of .......................................................................................................... and the fact state above is true to the best of my knowledge and belief. In case of a false statement, I am liable to any action Govt. may deem fit and proper. A treasury challan of Rs..............................................................................................is attached herewith Date................................. Signature of the Applicant
