GOVERNMENT SERVICE HOME Application for General Course 1. Name of the applicant (Tamil) .. (English) .. 2. Date of birth & Age .. (Certificate should be enclosed) 3. Religion / Caste .. 4. Educational qualification .. (Certificate should be enclosed) 5. Applicant address (Any change in .. address should be intimated) 6. Name of Father (OR) Guardian .. a) Address .. b) Occupation .. c) Annual income .. d) Relationship .. 7. Married (OR) Unmarried a) If the applicant is married state .. whether deserted or widowed (certificate should be enclosed) b) If unmarried, certificate for destitute below .. poverty line should be obtained (Income certificate below Rs.12000/- per annum should be obtained from Tahsildar) c) If the applicant is having children whether .. consent to admit the child in the home (Details to be given) 8. Whether the applicant belongs to this State .. If not, the details of migration to this state 9. Applicant's life details .. For what reason the applicant is interested to join in the home? If the applicant is deserted wife, the reason and the period of separation 10.Certificate of "No infectious desease" should .. be enclosed 11. Is there any legal case pending in the .. court against the applicant 12. How the applicant has survived so far .. 13. Has the applicant been employed .. anywhere, if yes, the details of place nature of job and period 14. The name & address of the 3 well known .. persons who knows the applicant 15. If admitted, the name & address of the .. visitors to be allowed during the visiting hours I declare that the above details are true to the best of my knowledge and there will be no change in that. If I am selected I assure that I will obey the rules and regulations of the Home. Candidate signature I the Father/Guardian of the applicant assure that the details given above are true. And also I assure that I will take back the candidate after training period of 3 years / 2 years/ 1 year or if the candidate is relieved from the Home for any other reason or if the candidate fell ill. Parent / Guardian signature
