No. A.12013/9/2014-HC(AB)/29(Part)
THE GAUHATI HIGH COURT
AiZAWL BENCH : AIZAWL
(Advertisement dated 18th February, 2016)
COMMON APPLICATION FORM
POST APPLIED FOR: _______________________________
Paste one
passport sized
coloured
photograph here
and sign across
the same.
1.
Name (IN BLOCK LETTERS)
:
____________________________________________
2.
Gender (M/F/Others)
:
____________________________________________
3.
Whether SC/ST (P)/ST (H)/OBC/MOBC/PWD)?
:
If so, self-attested photocopy of certificate should be furnished
4.
Father’s Name
:
____________________________________________
5.
Mother’s Name
:
____________________________________________
6.
Date of birth (as per HSLC)
:
____________________________________________
7.
Age as on the last date of submission of application
:
_______________________________
(Enclose self-attested photocopy of Birth Certificate/HSLC/School certificate)
8.
Nationality
9.
Whether married? If yes, whether more than one spouse living: _______________________________
10.
Spouse Name (In case of married candidates)
11.
Educational Qualifications (Enclose self-attested photocopies):
Exam
Year of
School/College/University
Board/Council/University
Name
passing
Sl.
No.
:
______________________________
_____________________________________________
:
__________________________________
Division
/ Class
Percentage
1.
2.
3.
4.
5.
12.
Stenography/Computer Typing/Typing Certificate
:
________________________________
(To be filled up by the candidates as per requirement
________________________________
indicated in the advertisement, and also enclose
________________________________
self-attested photocopies of certificates)
13.
Mention work experience/special skill, if any
:
________________________________
_________________________________________________________________________________
_________________________________________________________________________________
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14.
Professional Driving License No and date
:
(To be filled up by the candidates applying for the post of driver,
and also enclose self-attested photocopy of certificate)
________________________________
15.
Special or other qualifications, if any
________________________________
:
_________________________________________________________________________________
_________________________________________________________________________________
16.
Address for Correspondence
:
________________________________
_______________________________________________________________________________________
17.
Permanent Address
:
________________________________
_________________________________________________________________________________
18.
Is any FIR/Complaint/Criminal Case pending against
:
you in any police station/court? (If yes, give details
19.
Move you ever been convicted in a criminal case?
_______________________________
:
(If yes, give details)
20.
21.
Whether you have ever been terminated from service
_______________________________
________________________________
_______________________________
:
_______________________________
and/or whether any disciplinary proceeding had ever
_______________________________
been initiated against you? If yes, (Give details)
_______________________________
Have you even been debarred from any examination?
:
_______________________________
(If yes, give details)
________________________________
22.
Whether income tax assessee? If so, PAN/GIR No., If any:
_______________________________
23.
Telephone/Mobile No.
:
_______________________________
24.
E-mail id (if any)
:
_______________________________
25.
IPO (Indian Postal Order) No.
(Enclose the IPO)
:
_______________________________
Declaration: I have read the advertisement carefully before filling up the form I hereby affirm and state that the
abovementioned information is true and correct to the best of my knowledge and belief.
Place & Date:
Signature of the candidate
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