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Name in full (Block Letter)  
Post Applied for  
Present Salary (Rs)  
Min. Salary acceptable (Rs)  
Min. time required for reporting for duty in case selected  
Mother Tongue/ Languages Known  
Date of Birth Place of Birth    
Married/single/Blood Group Religion/caste    
Address for Correspondence  
Present address
  Name & Address of Institution Exam Passed Year of Passing Grade Subjects Studied
High School
Technical Professional
Name & Address of Present Employer’s Joined on Position held & Nature of Duties present Salary Reason for Wanting to Leaving
1.Are you related to any employees of this institution?
Yes No
Name Relation Position Department
2.Have you ever attended any Interview in this institution?
Yes No
Name of the post Date of interview
3. Have you undergone any major surgery in the past: if yes give the details?
4. Have you ever been dismissed/ discharged/ terminated for any act of misconduct in your
previous employment or convinced of any    criminal or other offence?
Yes No
5. Are you a deserter from the police or Defense force?
Yes No
6. Nearest person to be informed in case of emergency name & Phone No
Name Phone
7.How are you prepaid for the interview? Are you ready to attend a training programme If we provide?
Yes No
I certify that the above statements made by me are true, complete and correct to the best of my knowledge & are made in good faith. In the event the institutions finds at any information to the contrary of what is stated above, the institution will have the right terminate my services without Notice or Compensation