Sandard Form Blank PDF 2017 .pdf

STANDARD FORM OF APPLICATION
(As prescribed in the Part-IX of the Gazette of Meghalaya)

To

Passport Size
Photo

Dated: ________
___________________________________
___________________________________
___________________________________

Sir/Madam,
I beg to apply for the post of _________________________________________ and furnish
the facts/as below in case of any false statement I am liable to any action Government may deem fit and
proper. A Treasury Chalan of Rs. ____________ Vide T.V. No.___________ is attached herewith.

Signature of Applicant
1. Full name in capital letters with address; if any; Surname first
(Please do not use any initials):
________________________
Surname

__________________
Middle Name

________________________
First Name

2. Date of Birth:
____________
Year

____________
Month

____________
Date

3. Place of Birth:
_______________
Village/Town

_______________
Police Station

_______________ _______________
District
State

4. Father’s/Mother’s and Husband’s name (in case of married female)
(Please do not use initials):
_________________________________
5. Personal Description:
A. Height: ____ M ____ Cm
C. Colour of Hair:
________________________

6. A. Permanent Address in full:

B. Colour of Eyes: ___________
D. Visible distinguishing marks (if any):
__________________________________

B. Present Address in full:

_____________________________________

____________________________________

_____________________________________

____________________________________

_____________________________________

____________________________________

C. If you have not resided at the above address continuously for the last four years. Please give the
other address where you have resided during the period.
From: ____________ To: ____________

Address:
____________________________________
____________________________________
____________________________________
____________________________________

7. References:Name and address of two responsible persons in your localities who would be prepared to vouch for
you.
A. ____________________________________

B. __________________________________

____________________________________

__________________________________

____________________________________

__________________________________

____________________________________

__________________________________

8. Are you citizen of India? If so, how? (Copy of Citizenship Certificates should be enclosed where
necessary):
Yes, Indian by birth
9. Educational and other qualifications (Please attach copies of Certificates, Mark Sheets etc.)
Sl.
No.

Name of Institution and
Address
2

Board/
University
3

Examination
Passed
4

Subject
Taken
5

Year of
Passing
6

Divisio
n/Grade
7

Percentag
e
8

1

2

3

4

5

10. Community: ____________________
a) State your religion:
______________________________

(b) Are you a member of Scheduled Caste/Scheduled
Tribe? Answer “Yes” or “No”. If “Yes” give particulars
supported by a Certificate (Copy to be enclosed).
_______________________________________

11. Present Occupation, if any:
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________ _______________
12. Previous appointment held, if any:_____________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
13. Are you a temporary/retrenched personnel of temporary Department of the Government of Meghalaya, Answer
“Yes” or “No” (If “Yes” give particulars):________________________________________________________
_________________________________________________________________________________________
14. Are you married or unmarried?: ______________________
Signature
Note: Particulars are to be filled in below the column in the space provided.