Annexure-1 Control No (for office use):-

Roll No (for office use):-

RAILWAY RECRUITMENT BOARD, ........................................

APPLICATION FORM FOR Centralised Employment Notice No 02/2010 NO. ......
PLEASE FILL UP THE APPLICATION IN CAPITAL LETTERS IN OWN HANDWRITING. Paste(do not pin or staple)
Paste(do notrecent
here your pin orcolour
staple)
Signature should not be in Capital letters. here your
passport sizerecent colour of
photograph
(All applications must be submitted in A4 size 80 GSM bond paper)
passport sizesize
photograph of
Cat No Name of Post 4 cmsize
x 5 cm
1. Category No & Post 4 cm xphotograph
(The colour 5 cm
(For single category) (The colour
should not bephotograph
more than 3
Indicate options below in order of preference where single application is prescribed for more than one category shmonths
ould notold)
be more
Not tothan
be 3
(you will only be considered for the posts indicated below )
monthsattested.
old) Not to be
Option Cat No Name of Post
attested.
1
2

2. Choice of Railway: 1st 2nd 3rd

(wherever applicable)
3. Medium of examination : (Choose any one of the local languages of concerned RRB
as given in para 15 of notification , if other than English, Hindi & Urdu) Signature of the candidate in the above
box below the photograph

4. NAME OF CANDIDATE
(In English only)
5. COMMUNITY (Tick √) UR OBC* SC* ST*

* Community Certificate to be submitted in the form as prescribed in Annex -03 or Annex -04 as applicable

6. FATHER’S NAME
(In English only)
7. Date of Birth (DD/MM/YYYY) 8. Age years months days
(Age as on 01.07.2010, refer para 2 of Emp. Notice No. 02./2010)

9. Visible mark of identification on body

10. Qualification (Fill in only those qualifications prescribed for the post applied for)
Year of
(A) Academic Qualification University/Board Subjects Marks %
passing
SSC/X / Matric
Higher Secondary/XII/Inter
Graduation
Post Graduation
Others
Year of
(B) Technical Qualification University/Board Discipline/Trade Marks %
passing
I.T.I. /Act Apprentice
Diploma
Engineering Degree

Others

11. ADDRESS
(In English only)

(FOR CORRESPONDENCE)

State__________________________ PIN CODE

12. Nearest Railway Station

(In English only ) (for issue of free
railway pass to SC/ST candidates)

Left Hand Thumb Impression

of candidate in this box
Signature of the Candidate
Note : 1) Candidate must fill up their name, father's name and date of birth as indicated in their Matriculation certificate.

2) Candidate should put their full signature at all the places in the same language (In English or in Hindi)
 Annexu re-2
Ra ilway R ecruitment Board , . . . . . . . . . . . . . . . . . . . . . . . I n f o r m a t i o n S h e e t ( F o r C e n t r a l i s e d E m p l o y m e n t N o t i c e N o . 0 2 / 2 0 1 0 )
(To be filled in CAPITAL LETTERS only – Signature should not be in Capital /Open letters)

1. Name of Candidate (In English only)

2. Tick(3) Gender Female Male Marital Status Married Unmarried

3 . Na tio nality

4. P e rmanent Add ress : _____________________________________________________________

________________________________________________________________________
___________________________________________ State____________Pin cod e __________
5.(a) Details of Postal Orders/Demand Drafts enclosed:-
Name of Post office/Bank Serial No. & Date Amount

5.(b) Are you seeking Fee exemption (Y/N) (3 ) Tick appropriate box from the following
(i) As an economically backward class candidate (iii) As a Female candidate
(Income certificate to be enclosed as per annexure-7) (iv) As a SC/ST candidate
(ii) As a minority candidate(self declaration to be enclosed as per annex-8) (v) As an Ex- servicemen
Muslim Christian Sikh Buddhist Parsi (vi) As a Physically Handicapped

6. Religion : Hindu Muslim Christian Sikh Buddhist Jain Parsi other

7. Are You (i) Govt. Employee (Y/N) (ii) Ex-serviceman(Y/N)
(iii) Physically Handicapped (Y/N) if yes then deformity (VH/OH/HH)
8 . Present employment (To be filled by all Railway/Central/State/PSU employees)
Designation & Grade Date from Date to Name & address of Employer

9. Ex-serviceman(Ex-SM)
Date of Enrolment Date of Attestation Date of Discharge Length of Service

10 Do you seek age relaxation TICK (3) appropriate box

Judicially separated / J&K Railway Course completed Physically
SC ST OBC Ex-SM
divorced woman /widow Resident Employee Act Apprentice Handicapped
11. Whether you were debarred by any RRB in the past a) No b) For 2 years c) For life
12. Documents attached in proof of : Indicate by (3) Tick mark in the relevant boxes indicated below:-
Community Certificate(For SC/ST/OBC) Self Declaration Certificate (For OBC candidates as per Annx-5)
IPO/DD Discharge Certificate (for Ex-serviceman)
Colour Photograph (Passport size) Date of birth Certificate (As per Matric/High school or equivalent)
Educational Certificate Vision Certificate( required for the post of ASM/ALP as per Annex -6)
Disability Certificate(For Persons with Disability as per Annex-9)
Declaration from VH/ affected by cerebral palsy (For Engaging scribe as per Annexure-10)
Economically backward classes certificate(For Economically backward classes as per Annex-7)
Minority self declaration certificate(For Minority community as per Annex-08)
13. Please copy the following declaration in your own hand writing in running hand in the space provided below:
“I hereby declare that all the statements made by me in the application are true and complete to the best of my knowledge and belief
and nothing has been concealed or suppressed. I also understand that in case, any of my statements is found untrue during any stage
of recruitment or thereafter shall disqualify me for the post applied for and/or I shall be liable for any other action under the extant
rules.”_____________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

Left hand Thumb Impression

of candidate in this box
Place :
Date: Signature of the Candidate