Application Format by WAt23JxM


									           Application Format for Recruitment of Staffs for IGMSY/MAMATA

1. Post Applied For (Please write “Yes” or “No” against the positions you wish to apply for,
   CODE1&3, CODE5&7 and CODE6&8 to be applied in sets)

            State Level Positions                                  District Level Positions
Position Name            JOB      Application         Position Name               JOB       Application
                         CODE     (Yes / No)                                      CODE      (Yes / No)
State Coordinator for    CODE1                        District Coordinator –      CODE5
IGMSY Scheme                                          IGMSY Scheme
Consultant (for             CODE3                     District Programme          CODE7
programme ) –                                         Coordinator – MAMATA
State Level Programme       CODE2                     District Programme          CODE6
Assistant - IGMSY                                     Assistant – IGMSY
Consultant (for             CODE4                     District Programme          CODE8
monitoring &                                          Assistant – MAMATA
evaluation) – MAMATA

2. Name (Full Name in block letters): _____________________________________

3. Sex: Male / Female (strike one)

4. Date of Birth: _____(Date),_________(Month),________(Year)

5. Marital Status: Married / Single (Strike one)

6. Name of Father / Husband:

7. Permanent Address:

8. Address for Communication:

9. Mobile Number for Contact:

10. E-mail id:

11. Educational Qualification: (Only Government recognized degrees / diplomas will be considered.
    Please note that you will be eligible if and only if the results have been declared and you can produce
    the certificate at the time of selection process. Give only formal degrees in this section, no certificate
    courses / computer courses to be added)

Level                   Institution and University             Degree/Diploma and          Year of Passing
                         (if applicable)                       Specialization
Post Graduation


Other formal degrees
/ diploma (if any)

12. Total years of experience ___________

13. History of employment starting from the most recent one (Use more pages as per need in the
same format. The responsibility column should highlight the kind of activities undertaken which are
most relevant to the position All experience will be backed by proof to be produced at the time of
selection process)

Sl No.   Organisation    Designation     Period (From –        Key Responsibilities
                                         To) and location



14. Computer literacy (Please write Yes or No)

Proficient in MS-Office (World / Excel / Power Point) – Yes / No
Experience in Data Entry: Yes / No
Experience in Data Analysis: Yes / No

Give details of certificate / courses completed in computer application / software / data analysis:

15. Medical History (Give details of Physical /mental disabilities & serious ailments if any):

I hereby agree that information given here is correct and any information if found to be incorrect will
lead to rejection of candidature.

Place:                                                                   Signature of the applicant
                                                                 (Pl. digitally sign the application)

To top