1/1/14 MINI RATNA PSU: APPLICATION FORM

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Mini Ratna PSU 2013
Application Form for Post Code: 04

* Application No.
*324625*

* Application for the Post of Jr. Technical Assistant (Post Code: 04)
* Test Centre
Choice1: LUCKNOW
Choice2: PATNA
*
Language in which you want
to take the Written Test:
ENGLISH

Personal Particulars
* Candidate Name Mr. MANOJ KUMAR BHARATI * Father's Name CHHOTE LAL RAM
* Address for Communication VILL-PHEPHANA POST-PHEPHANA
DISTT.-BALLIA
* City BALLIA * Pin Code 277503
State UTTAR PRADESH
* Email-ID manojbharti951@gmail.com Alternate Email-ID chandra104bhan@gmail.com
Contact No. - Mobile No. 7309092675

* Date of Birth 07-Jul-1989
* Gender Male * Category SC
*
Whether Kashmiri Migrant?
(Are you ordinarily been domiciled in the Kashmir Division of
the State of Jammu and Kashmir during the period 01-01-
1980 to 31-12-1989?)
NO
*
Are you Departmental
employee of the
organisation?
NO
if yes, specify Month & Year
of superannuation date
-
*
Are you a person with
Disabilities?
NO
If yes, Nature of Disability &
Degree
Whether Guide/Scribe is
required at the Examination
Centre?

..................................
Signature of Candidate
1/1/14 MINI RATNA PSU: APPLICATION FORM
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Application No.: 324625
*324625*
Qualification Detail
Academic/
Professional
Qualification
Discipline/
Specialization
University/Board Main Subjects
Year of
Passing
Percentage Division
Matric - CBSE
HINDI,ENGLISH,MATHS,SOCIAL
SCIENCE,SCIENCE,
2004 71.00 FIRST
12th SCIENCE(BIOLOGY) CBSE HINDI,ENGLISH,BIOLOGY,PHYSICS,CHEMISTRY 2006 70.40 FIRST
Graduation
Degree Name:
DEGREE IN
AGRICULTURE
AGRICULTURE BHU AGRICULTURE 2013 81.30 FIRST
Professional/PG
Degree Name:
Any Other
Qualification:

Experience Details(Backwards from Present Position)
Name and Address of the Employer Position Held
Period of Employment
Remarks, if any
From(MM-
YYYY)
To(MM-
YYYY)
- -
- -
- -
Demand Draft Details (Not Applicable for SC/ST & PH Candidates)
* DD No. * DD Date --
* DD Amount 0/- * Issuing Bank's Name
Declaration
I hereby declare that all statements made in the application are true, complete and correct to the best of my knowledge and belief. In the
event of any information being found false or incorrect at any point of time, my candidature/appointment may be cancelled/terminated without
any notice. I also declare that I am a citizen of India by birth/domicile.
Place
Date Signature of Applicant
(To be signed prior to despatch)
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Print
(Please Print the form for Further Reference)
CERITIFICATE FROM THE PRESENT EMPLOYER (Wherever applicable)
(For candidates serving in Central Govt./State Govt./Public sector Undertaking/Autonomous bodies)
Certified that the above mentioned information furnished by the officer is true and there is no Vig./Disp. Case pending against
him/her.
(Signature & Seal of Employer)
..................................
Signature of Candidate
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Important Instruction for Candidates:
1. Attach your two passport size photograph (without attestation) in the space provided.
2. Endorse your signatures in the space provided.
3. Application form received without two photographs, signatures, Self attested documents viz. Qualification, Experience,
Age, Caste etc. will be rejected.
4. Send the duly completed application form in single envelope superscribing "Application for the post (name of the post
& Post Code No.) Category:________" should reach by 18 January 2014 to:
Post Box No. 4334,
Kalkaji Head Post Office,
New Delhi-110019
5. The applications received after the closing date will not be entertained
6. Self attested Photostat copies of documents in proof of Age; Qualifications (including all mark sheets clearly
indicating the division of passing/%age of marks & specialization certificate in case of MBA), Caste etc. should
be attached with the printout of Application Form having auto generated Application Number. Application /
Copy of the Registration Slip Original certificates will, however, be scrutinized / verified at the time of
interview.

Application No.: 324625
*324625*
Name: MANOJ KUMAR BHARATI
Address: VILL-PHEPHANA
POST-PHEPHANA
DISTT.-BALLIA
BALLIA-277503
UTTAR PRADESH
Test Date: 02 March 2014 (Tentative)
Signature of Applicant
(in the space provided)
1/1/14 MINI RATNA PSU: APPLICATION FORM
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Please Cut & Affix the Address Label given below on the envelop for sending Application/ Registration Slip(print version of
Online Application Form) and relevant Self Attested copies of certificates/testimonials
------------------------------------- --------------------------
Application for Mini Ratna PSU 2013
Post Applied: 04-Jr. Technical Assistant
Category: SC
To
Post Box No. 4334,
Kalkaji Head Post Office,
New Delhi-110019
------------------------------------- --------------------------