APPLICATION FORM
Resent
(To be sent neatly typed or hand written)
Passport size
(DAVP Advertisement No_____________)
photograph of
To, the applicant
(Unit Address as mentioned
atpara 1 of advertisement)
1. Post applied for (along with Unit as : _________________Unit______________________
Mentioned at para 1 of advertisement)
2. Name of the candidate : ____________________________________________
(In Block letters)
3. (a) Father’s /Husband’s Name : ____________________________________________
(b) Mother’s Name : ____________________________________________
4. Date of Birth (DD/MM/YYYY) : / /
5. Age as on last date of receipt : Years_______Months _______Days
Of application
6. Nationality : _____________________
7. Religion : _____________________
8. Correspondence address 9. Permanent home address
Pin-___________State________________________ Pin-___________State________________________
Contact/Mobile No__________________________ Contact/Mobile No__________________________
Email ID________________________________ Email ID________________________________
10. Category (UR/SC/ST/OBC/EWS(UR)/ESM):
( Please enclose photocopy of relevant certificate)
Abbreviations used: UR- Unreserved, SC- Schedule Caste, ST- Schedule Tribe, OBC- Other Backward
Class, EWS- Economically Weaker Section, PwBD- Person with Benchmark Disability,ESM- Ex-Serviceman
11. If applied for the post in “Physically Handicapped” category:
Type of disability (B, LV, D, HH, OA, OL, OAL, CP, Percentage of disability (40 % and above)
LC, Dw, AAV, ASD (M, MoD), SLD (M), MI(M))
(Please enclose photocopy of disability certificate issued by CMO/Civil Surgeon of Government hospital
certifiying the disability duly self attested)
Abbreviations used: B- Blindness, LV-Low Vision, D-Deaf, HH- Hard of hearing, OL-One leg ,OA-One Arm,
OAL- One Arm and One Leg, CP- Cerebral Palsy, Dw- Dwarfism, AAV- Acid Attack Victim, LC-Leprprosy
Cured, ASD(M,MoD)- Autism Spectrum Disorder (M-Mild, MoD- Moderate), SLD(M)-Specific Learning
Disability(M-Mild),MI(M)-Mental IIIness (Mild), MD- Multiple Disability
12. Length of Combatant Service (applicable for ESM only): Years___________ months________Days_______
Date of enrolment (In Army/Navy/Air Force):___________________ Date of retirement:________
(Please enclose photocopy of discharge certificate)
13. Details of age relaxation required_________________________________________________
(Applicable as per Central Govt Policy)
14. Qualifications:
(i) Educational:
Name of examination Year Board/ University/ Institution Percentage of Grade/
marks obtained Division
(Please enclose photocopy of educational/qualification certificate)
(ii) Experience:
Organization Whether Post/Appointment Form To
Govt/PSU/Private
(Please enclose photocopy of experience certificate)
15. List of enclosures:-
Ser Enclosures
(a)
(b)
(c)
(d)
(e)
16. Details of any Identity proof (Enclose copy):-
Aadhar Card No: PAN Card No:
Driving Licience No: Passport No:
DECLARATION
I hereby certify that above particulars mentioned in the application are correct and true to the best of
my knowledge and belief. There is no criminal proceeding pending/ contemplated/ held against me. I
understand that in the event of my information being found false or incorrect at any stage or not satisfying the
eligibility criteria according to the advertisement, my candidature/ appointment is liable to be cancelled/
terminated. I am willing to serve anywhere in India. I agree that Department has the right to transfer me
anywhere in India.
Place :
Date: (signature of the applicant)
Note: Candidate to ensure the following are enclosed:-
(i) One self-addressed envelope duly affixed with Rs 5/- postal stamp.
(ii) Self-attested photocopies of certificates(________________)sheets.
(iii) Two self- attested Photocopies (Name and Mother’s/Father’s name on the back side of photo
(iv) Acknowledgement/Admit card
ACKNOWLEDGEMENT / ADMIT CARD
1. Post applied for_____________________________________________________
2. Unit applied for_____________________________________________________
3. Name of candidate_________________________________________________ Resent Passport size
photograph of the
(IN BLOCK LETTERS) applicant
4. Date of Birth________________________________________________________
5. Mother’s Name_____________________________________________________
6. Father’s/ Husband’s Name_____________________________________________
7. Category applied for_______________________________________________________
8. Correspondence address
House No./Street /village________________________________________________
Post Office_____________________ Tehsil_________________________
District________________________ State____________________ Pin Code_____________
9. Tele/Mob No________________________ E mail ID_____________________
FOR OFFICE USE ONLY
Your application is hereby accepted
10. Index No____________________
11. Written test (a) Date_______________________(b) Reporting Time________________________
(c) Place__________________________________________________________________
Date: (Signature of controlling officer)
Note:- (i) Candidate will report for written test along original documents / certificates i.e. Educational,
Caste, Domicile, Birth, discharge certificate/NOC and Physically Handicapped certificate. Only after
Verification of original documents and Biometric Attendance, candidates will be allowed to appear
for written test. The custody of the documents is the responsibility of the individual.
(ii) Candidates should reach at least one hour before the scheduled time at examination centre on
aforementioned date. No candidate will be allowed for examination after scheduled time.
(iii) The candidate should bring their pen, pencil and clipboard for written Examination. Candidates will
also carry any two proof of identity (Aadhar Card/PAN card Passport/Driving Licence)
(iv) The candidates should not keep Mobile, Calculator, Electronic item, paper and other material
otherwise he/she will not be allowed for examination and his/her candidature will automatically deemed to be
rejected.
CBC 10103/11/0004/2425
