Board of Apprenticeship Training (Southern Region)
                             Application for the post of Lower Division Clerk (Reserved for OBC)

 Application Date of           Initial of
    No.      Receipt           Authority                                                          Affix Recent
                                                                                                  Passport size
         (For office use only)

 1. Full Name in Block Letters              :
    (As per school record)

 2. Father’s/Husband’s Name                 :

 3. Nationality / Religion                  :
 4. Community                             :         OBC
   (Enclose attested Xerox Copy of
    OBC Certificate in prescribed format)

 5. Sex (tick mark)                         :Male                               Female

 6. Date of Birth in Christian era          :
 (As per school leaving certificate,
 attested copy is to be enclosed)               (Day)                   (Month)                   (Year)

 7. Age as on last date of submission       :
    of application
                                                (Year)                (Month)                 (Day)
 8. Please mention if physically
    Handicapped / Ex-Serviceman             :
    (supporting document to be                  --------------------------------------------------------------------
    enclosed where necessary)

9.a)    Address for Communication           :
        (in Block letters with-Pin code)

 b)     Tel. No.(with STD code)

 c)     E-mail                              :

  d)    Permanent Address                   :
        (in Block letters–with Pin code)

10.     Educational qualifications Matriculation/SSLC onwards. Including Typing Proficiency Certificate
        issued by DTE / Govt. Authorities. Enclose attested Xerox copies of certificates (attach separate
        sheet if required).
                Exam            Name of        Board Which Month & Year         Class/Div         % of Marks
Sl. No.                                                                                                              Remarks
               Passed         School/Instt.    Awarded Deg.     of passing      Secured            obtained
                                              /Dip. Certificate

11. Experience starting from present employment – in ascending order. Enclose attested Xerox
      copies of certificates (attach separate sheet if required)
                                                                             Period of          Scale of pay
                                                                              Service                & total
               Name of the            Designation                                               emoluments
  Sl.                                                 Temporary                                                      Remarks
               organisation           / Post held                                               at the time of
  No                                                 Or permanent
                                                                      From           To             leaving

12.       Any other additional information,
          relevant to the post applied for                     :
13.       List of attested copy of documents                   :

14.       Declaration
          1.      I hereby solemnly declare that all the statements made in this application are true,
                  complete and correct to the best of my knowledge and belief.
          2.      I also declare and fully understand that in the event of any information furnished being
                  found false or incorrect at any stage my application/candidature is liable to be
                  summarily rejected.
          3.      I am also aware that if any falsification of information including certificates furnished
                  above is / are detected later, after appointment to the post applied for, my service is
                  liable to be terminated without any notice, not withstanding further disciplinary action.

                                                                                           Signature of the applicant

          Place :                                                                              Name of the Applicant
          Date:                                                                                     (in block letters)

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