GOVERNMENT SERVICE HOME Application for Higher Secondary Course (Residential course) 1. Name of the applicant (Tamil) .. (English) .. 2. Date of birth & Age .. 3. Mother tongue .. a) Nationality .. b) Religion .. c) Caste BC /SC/ ST .. 4. Father (OR) Guardian a) Name .. b) Occupation .. c) Annual income .. 5. Permanent address .. 6. Present address .. 7. Married / Unmarried If the applicant is deserted or divorce .. certificate should be enclosed 8. Educational qualification and the details .. of school studied. 9. If the applicant is physically handicapped .. the details should be furnished and certificate should be enclosed. 10. How the applicant survived so far .. 11. Is the applicant employed anywhere, .. if yes, the details of place and nature of job and period 12. The name & address of the 3 well known .. persons who knows the applicant 13. The address of the visitor in case of .. admission to be allowed during the visiting hours (only two visitors will be allowed) I assure 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 you that I will obey the rules and regulations of the Home. Date: Applicant's signature I am the Father/Guardian of the applicant, given above, I 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
