Documentos de Académico
Documentos de Profesional
Documentos de Cultura
dZJe
<kÙte : Je. yum. dZJe J[to - 25 ] <t. 1 - 7 yurºj, 2003 [ ykf lk. 18
mkvt¥f : ºftN jtjt ftgoJtnf mkvt¥f : bnuNfwbth htKt mnmkvt¥f : Je. su. bumhegt
mkvt¥f : ºftN jtjt ftgoJtnf mkvt¥f : bnuNfwbth htKt mnmkvt¥f : Je. su. bumhegt
Ó»sht< htusdth mbtathL»k Jtr[tof jJtsb Y. 30 Au. jJtsb btrn<e rlgtbfle fauhe, rnmtce NtFt, çjtuf lk. 7/3, ztp. SJhts bnu<t CJl, dtkHeldh, Wvhtk< rs§jt-<t§»ft
Ft<ule btrn<e fauheyu MJefthJtbtk ytJu Au. jJtsb WDhtJJt btxu yt fauheyu ftuE yrHf$< yusLxle rlbóËf fhe l&e. [R.N.I. No : 33297 / 78] [Regd. No. G /GNR / 47 / 78]
(û\[X - 8 L»k at§») He jtEV RLMgtuhLm fkvle rjrbxuz ..... trate / Collector / Deputy Commissioner / ytJt Wbu¥Jthtu sYhe Ve mt&ule yhSle yuzJtLm
Deputy Collector / First class Stipendary Mag-
u Wbu ¥ Jthtu y u rzbtLz z# t VT x le vtA¤ <u b lw k ltb / istrate / Sub-Divisional Magistrate / Taluka
ftuve rlg< Au§je <theF vnujtk b¤u <u he<u btufje
mhltbwk, d{qv ylu ftuz lkch ¥NtoJJtlt hnuNu. Magistrate / Executive Magistrate / Extra Nfu Au.
Assistant Commissioner (not below the rank u jurF< vhe]ttbtk Wbu¥Jthtult ¥uFtJ ylu sdtle
u Wbu¥Jthtuyu yuflt|jusbuLx btxu Y. 6ltu vtuMxus vuEz of First Class Stipendary Magistrate).
vtuMx ftzo vtu<tlwk ltb, mhltbwk ¥NtoJelu btufje b. Chief Presidency Magistrate / Addittional Chief
mk Ï gtlu ytHthu RLxhÔGË btxu fu x jt Wbu ¥ Jthtu l u
ytvJtltu hnuNu. Presidency Magistrate/ Presidency magistrate. ctujtJJt <ule mkÏgt låe fhJtltu fkvle / ftuvtuohuNl
c. Revenue Officer not below the rank of Tehsildar. yctrH< yrHfth HhtJu Au.
u Wbu¥Jthtulu Y. 5le xvtj rxrfx atUxtzuj 23 x 12 d. Sub-Divisional Officer of the area where the
candidate and/or his family normally resides. u OIC / GICle Cth<Chbtk fauheytu ytJuje Au ylu
mu.be. mtRÍlwk vtu<tlt ltb mhltbtJt¤wk vhcerzgwk
e. In so far as the Schedule Tibes community of vmk¥de vtbujt Wbu¥Jthle sYhegt< bwsc ftuE vK
btufjJtlwk hnuNu.
Tamil Nadu is concerned, the Certificate given fauhe Ft<u rlbKqf fu c¥je &E Nfu Au ylu yt
r yhSvÙtf mt&ultk rcztKtu : by the Revenue Divisional Officer instead of ctc<tubtk Wbu¥Jthtule rJlk<e fu vmk¥delu âgtlbtk
u sLb <theF ¥NtoJ<wk yum.yum.me.lwk ºbtKvÙt. Tehsildar would only be accepted.
5. For claiming reservation under OBC category juJtbtk ytJNu lné.
u rzd{e ºbtKvÙt ylu dwKvÙtftu. candidate should belong to such Caste or Com- u cHe ctc<tubtk fkvleltu / ftuvtuohuNltu rlKog ytFhe
u ylwCJ ylu ydtWle ltufhelu jd<t ºbtKvÙttu. munity which is common to both the lists in ylu ¥huf Wbu¥Jthtulu ckHlf<to hnuNu. yhSJt¤e
respect of Mandal Commission and the State
u ïr<lwk ºbtKvÙt ïu jtdw vz<wk ntug <tu rlg< vÙtfbtk Government Lists from the State of his origin xvtjlt rJjkc fu xvtjle Ftuxe JnUaKe y&Jt FtuJtE
u btS mirlf Wbu¥Jthtu btxu herjÍ yt|zoh. (as per the list published by the Central Gov- sJt c¥j fkvle / ftuvtuohuNl sJtc¥th hnuNu lné.
ernment). The benefits of reservation shall not
u Nt.Ftu.Ftk.lt Wbu¥Jthtu btxu m]tb mÃttrHftheyu ytvuj u rlr¥o™ rcztKtu mt&ulwk mkvqKo Chujwk yhSvÙtf leault
apply to persons/section belonging to ‘Cramy
ºbtKvÙt. Layer” as specified vide Column 3 of the Sched- mhltbu <t. 10-4-2003lt htus fu <u vnujtk vntUau
ule of the Department of Personnel and Train- <u he<u btufje ytvJtlwk hnuNu.
u ft|BûG»xh yuÛG»fuNlL»k ºbtKvÙt ïu ntug <tu. ing OM No. 36012/22/93 - Estt (SCT) dated 8- Post Bag No - 2281,
u Jfejtu btxu cthbtk ltUHKeL»k ºbtKvÙt ylu m]tb 9-1993. Candidates should produce Certificate
Chanakuapuri Post Office,
as per Proforma prescribed by Ministry of Per-
mÃttrHftheyu ytvuj Jfejt< fh<t ntuJtL»k ºbtKvÙt. sonnel, Public Grievances and Pensions, Govt. New Delhi - 110021
y.ï. / y.s.ï. ylu y.v.J.lt Wbu¥Jthtuyu leau of India which should include that they do not Wbu¥Jth ‡tht ftuE jtdJdltu ºgtm fhtNu <tu <u <uble
¥NtoJuj m]tb mÃttrHftheyu ytvuj ïr< ykdulwk ºbtKvÙt belong to “Creamy Layer.” du h jtgft< dKtNu . gtu Ó g<tle Nh<tu vrhvq K o fh<t
hsq fhJtlwk hnuNu. u mhfthe / yHo mhfthe / ïnuh mtnmtubtk muJt cïJ<t Wbu¥Jthtuyu yhSvÙtflt lbqlt ºbtKu <uble yhS btufje
a. District Magistrate / Additional District Magis- Wbu¥Jthtuyu <uble yhS gtuÓghtnu btufjJtle hnuNu. ytvJtle hnuNu. à
Ó»sht< htusdth mbtath, <t. 1 - 7 yurºj, 2003 7
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àAPPLICATION FORMAT FOR THE POST OF ASSISTANT ADMINISTRATIVE OFFICER 123456789012345678901234567890121234567890
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1. Group applied for_______________________ Group Code : _____________________ Affix yLg ïnuhFchtu Wvh yuf lsh...
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Passport
Area of Specialization, if any : _____________________________________________ Size { f$ r [t rJ¿ttl fu L …, ve.S. ft| j u s , dtrÍû»h -
2. Choice of centre for Written examination : ______________ Code No _____________ Photograph 233001 (G»ve), sdtL»k ltb : x#uÀld yumturmgux,
3. Name in full : Shri / Smt / Kum : _______________________________________________________ yt| r Vm M»rºLxu L zu L x fb yu f tWLxLx, x# u À ld
(In block letters) Surname First Name ytrmMxLx Jduhu, sdtle mkÏgt : 5,
4. Father’s / Husband’s Name : ___________________________________________________________ yhS MJefthJtle Au§je <theF : 11-4-2003.
5. Address for correspondence : ______________________________________ pin Code ___________ { G»rlgl vÂçjf mrJom frbNl : lJe r¥§ne,
Nearest Railway Station : _____________________________________________________________ sdtL»k ltb : ºtuVumh El Rjuƒx#turlfm yuLz
6. Permanent Address : ____________________________________________ Pin Code ____________ Rjuƒx#fj ft|BG»rlfuNl yuÂLsrlgÀhd, swrlgh
7. Category : SC ( ) ST ( ) OBC ( ) ECO/SSRCO ( ) PHYSICALLY HANDICAPPED ( ) mtgÂLxrVf yt|rVmh (furbMx#e), rmrlgh Rftulturbf
UNRESERVED GENERAL ( ) Please tick whichever is applicable and attach an attested copy of the yuzTJtRÍh Jduhu, sdtle mkÏgt : 3,
Caste Certificate / Release Certificate as may be applicable. yhS MJefthJtle Au§je <theF : 13-4-2003.
Note : Candidates belonging to OBC but coming in the “Creamy Layer” and thus not entitle to OBC { G»rlJrmoxe d{tLxTm frbNl : lJe r¥§ne,
reservation should tick their category as GENERAL. sdtL»k ltb : sw r lgh rhmao Vu j tu N ev yu L z
8. Whether a resident of Assam, from 01.01.1980 to 15.08.1985 Yes ( ) No ( ) Please yurjrsrcrjxe Vtuh jufahhNev btxu luNlj
If yes, attach a copy of documentary evidence to that effect. tick in yuÛG»fuNl xuMxéd (lux), sql - 2003 vhe]tt
appropriate yhS MJefthJtle Au§je <theF : 25-4-2003.
9. Whether confirmed employee of GIC/Public Setcor General Yes ( ) No ( )
bracket { luNlj rhmao muLxh Vtuh bNYb aBctDtx : mtujl
Insurance Company / Corporation / TAC / LPA.
- 173213, sdtL»k ltb : rmrlgh rhmao Vujtu
If Yes, S. R. Number :_________________________________ Designation : ___________________
Jduh,u sdtle mkÏgt : 2,
Name of the Company/Corporation : _________________ Place of Posting : ____________________ yhS MJefthJtle Au§je <theF : 7-4-2003.
Date of Confirmation : ________________________________________________________________ { sglthtgK Ôgtm G»rlJrmoxe : ïuHû»h
10. Date of Birth : ______________________ Age in completed years : ___________ (as on 31-03-2003) sdtL»k ltb : htsM&tl bulusbuLx yuzTrbNl xuMx
11. Place of Birth : __________________________ State of domicile : ___________________________ (RMAT) 2003,
12. Marital Status : Married ( ) Unmarried ( ). (Please tick whichever is applicable) yhS MJefthJtle Au§je <theF : 5-5-2003.
13. Qualifications : { slhj bulush (yuaythyum) yuayum.meme
Name of Exam Year of Aggregate Class/ Specialization (RÂLzgt) rjrbxuzu, ltuEzt (G»ve) 201301,
University/ Passed Passing Marks (%) Division sdtL»k ltb : ft|BûG»xh ytrmMxLx Jduhu,
Institution Exam or Rank yhS MJefthJtle Au§je <theF : 11-4-2003.
1. Graduation { ytuzuolLm Vufxhe, Exthme (yubve) - 461122
2. Post Graduation
sdtL»k ltb : rmrlgh lmo d{uz - II (rVbuj),
Mxtuhrfvh, Vtgh yuÂLsl z#tgJh d{uz-yu Jduhu,
3. Any other
sdtle mkÏgt : 16,
14. Non Life insurance Qualification Please tick
yhS MJefthJtle Au§je <theF : 7-4-2003.
(i) Insurance Institute of India : (Associate ( ) Fellow ( )
{ bNel xq j ºtu N u x tEv Vu f xhe : yck h ltb -
(ii) Chartered Insurance Institute : Associate ( ) Fellow ( ) 421502, sdtL»k ltb : bNerl™ (murbMfe§z),
(iii) General Insurance Vocational Course at 10+2 level : Yes ( ) No ( ) bejhtEx (murbMfe§z) Jduhu, sdtle mkÏgt : 4,
(iv) Graduate with Insurance as optional subject : Yes ( ) No ( ) yhS MJefthJtle Au§je <theF : 11-4-2003.
15. Particulars of post qualification previous and present employment / experience, if any. (Attach { muLx#j çGËhtu ytuV RÂLJMxeduNl, jtu¥e htuz : lJe
separate sheet if necessary). r¥§ne - 110003, sdtL»k ltb : ftuLMxucj (buj-
Previous Present rVbuj) Jduhu, sdtle mkÏgt : 101,
a. Name of the employer/s yhS MJefthJtle Au§je <theF : 10-4-2003.
b. Date of joining ltUH : Wvhle ïnuhFchle JHw rJd<tu btxu r¥§ne&e
c. Posts held ºrmØ &guj <t. 15 - 21 btao, ylu <t. 22 -
d. Salary last drawn 28 btao, 2003lwk yuBûjtugbuLx LGËÍ ïuJt rJlk<e.
e. Nature of work M&¤ mkftualt fthKu su ïnuhFchtultu mbtJuN fhe
f. Number of completed years of experience
Nftgtu l&e <uJe Wvh rlr¥o™ ïnuhFchtule xqkfe rJd<tu
Wbu¥Jthtule ïKfthe btxu ºM<w< fhe Au. Wbu¥Jthtuyu JHw
g. Date of leaving
rJd<tu btxu su <u rlr¥o™ fhuj mbtathvÙttu fu yuBûjtugbuLx
h. Reason for leaving
LGËÍbtk ºrmØ &guj ïnuhFch ïuJt rJlk<e Au. l
16. Examination fee of Rs. 250/- : Demand Draft No. ___________ Date ___________ Complete address
of issuing of the Bank from where the Bank Draft is purchased. (No examination fee is required for
M»Hthtu
SC/ST/PH/EXSM Candidates applying for the post, and for confirmed employees of GIC and General
ins. Public sector Company or LPA or TAC). ykf lk. 17, <t. 25 - 31 btao, 2003btk
º&b vtl Wvh juJtguj Ó»sht< ïnuh muJt ytgtudle
I hereby declare that all the statements made in this application are true and correct to the best of my
rJ¿ttvllt ï.¢btkf 79btk Nh<ÉËf&e Ni]trKf jtgft<
knowledge and belief.
hne dguj Au <tu yt Ni]trKf jtgft< yt B»sc Au.
I understand that in the event of any information being found false or incorrect, my candidature for the Ni]trKf jtgft< : btLg G»rlJrmoxele rbfulefj
applied post is liable to be cancelled/rejected at any stage without notice to me. yuÂLs. y&Jt ºtuzfNl yuÂLs.le º&b Jdole Mlt<fle
Date :____________________ __________________ v¥Je y&Jt <ule mbf]t jtgft<.
Place :___________________ Signature of Applicant ctfele rJd<tu g&tJ< Au.
l
8 Regd. No. G/GNR/47/78, R.N.I. No. 33297/78 Licensed to post without prepayment Licence No.001 <t. 1 - 7 yurºj, 2003, Ó»sht< htusdth mbtath