Regional Science Centre
(National Council of Science Museums)
Govt. of India
Jawahar Nagar, Khanapara
Guwahati- 781022
Affixed recent
passport size
photograph duly
attested by a
Gazetted Officer
Application for the post of Driver (Reserved for OBC) vide Advertisement No. 01/2014.
In the Pay Band of Rs.5,200-20,200/-(PB-1) with Grade Pay Rs.1,900/1.
Name in full (in Block letters)
-----------------------------------------------------------------------------------------------------------------------------2.
Address:
Present—
Permanent—
3.
Date and place of birth:
4.
Father’s Name
Address*
Occupation*
(if dead, state his last address, in case of married woman give husband name, address and
occupation)
5.
Issuing Authority of the Caste Certificate :
6.
Are you (a) a citizen of India by birth and/or by domicile ?
OR
(b) a person having migrated from Pakistan or Bangladesh or
other countries with the intention of permanently settling in
India or a subject of Nepal ?
YES/NO
7.
Are you an Anglo Indian
YES/NO
8.
Name of the State to which you belong
9.
Particulars of educational qualifications:
Examination
passed
(1)
i)
ii)
Name of
school/college
Universities
(2)
Date
Place
Division/class
obtained
(3)
Year of passing
(4)
Subjects taken
(5)
10.
Particulars
of
professional/technical qualification:-
Professional / Technical
qualification
(1)
11.
Name of Institution
Year of passing
(2)
(3)
Experience (give details of all employments): -
Nature
employment
(1)
12. (a)
(b)
of
Name
employers
(2)
of
Date of joining
Date of leaving
(3)
Salary & grade
(4)
Driving License No. & issuing authority
:
Validity
:
(5)
13. Languages Known :Read
Write
Speak
___________________________________________________________________________________________________
14.
Are you a Government servant at present?
If so, please state whether your appointment
is temporary or permanent
____________________________________________________________________________________________________
15.
Are you willing to accept minimum initial
pay offered? If not, state the lowest initial pay that
you would accept in the prescribed scale
____________________________________________________________________________________________________
16.
Have you any relative working in this Museum/ centre ?
If so, please give details.
___________________________________________________________________________________________________
Note : 1) Information in respect of columns 5,9,10,11,12 & 14 should be supported by attested copies
of
certificates and testimonials otherwise the application will not be considered.
2) If in Govt./Semi Govt. service, application should be routed through proper channel.
3) Canvassing in any form/or bringing in any influence, political or otherwise, will be treated as
disqualification for the post.
Date :
………………………………………………
Candidate’s signature
Endorsement by the present employer (if he is a Govt./Semi-Government servant)
No._________________________
Date _____________________________
Signature ______________________________________
Designation ____________________________________