- 2 - 7. Details of employment (including present employment) on regular basis in chronological order. A separate sheet duly authenticated by the Officer should be enclosed, if the space below is insufficient. Office / Institution / Organisation Post held Scale of pay and last basic pay Nature of duties From To 8. Experience with special reference to the post applied for : 9. Training experience, if any : 10. Whether belongs to ST (If so, copy of the Community Certificate to be enclosed) : 11. Date of return from the last deputation post : 12. Complete Official address of the candidates including Telephone Number, if any : 13. Substantive post if any held indicating the scale of pay of the post and present substantive pay : 14. Post held at present indicating the scale of pay of the post and present pay : 15. Date from which the above post is held on regular basis : - 3 - 16. Additional details about present employment. Please state whether working under a) Central Government b) State Government c) Autonomous Organisations d) Government Undertakings e) Universities : 17. Total emoluments per month now drawn : 18. Additional information, if any, which you would you like to mention in support of your suitability for the post. : 19. Remarks : Date : Signature of the Candidate Place : (To be filled by Employer) 1. It is certified that the information furnished by Shri/Smt./Kum. ____________________________________ has been checked as per the service record of the individual and found correct. 2. In the event of selection of the Officer, he / she will be relieved of his/ her duties in the office. 3. No Disciplinary / Vigilance case is pending / contemplated against the Officer. 4. No minor / major penalties have been imposed upon the officer during the last ten years. 5. The Integrity of the Officer is beyond doubt. 6. Upto date ACRs for the past 5 years enclosed. 7. Cadre Clearance: The Office has no objection for appointment of the Officer, if he/ she is selected for the post of Labour Officer on transfer on deputation basis. Date : Signature : Place : Name : Designation : Telephone No. : Office Seal :
