Indian Oil Corporation Limited IndianOil Selection to Officer Grade under Accelerated Career Progression Scheme (ACPS) 2019 PASSPORT Si/ PHOTOGRAPH (Through Proper Channel) Subject! |. Graduate in Engineering or equivalent ~T Disciplines * (Please “¥") | a. Chemical [] eFire & Satety b. Civil 8. Instrumentation ©. Computer Se & Engg h, Mechanical | a. Btectrica i. Metallurgy | ©, Electronics & Comm h, Others (PI Specify)... 2. Post Graduate in Management or equivalent a. Finance b.HR ¢. Marketing L Isc Icwa J mca 5. PhD (Chemistry) ] No of attempts already made (including written test conducted by Corporate Office during 2013 to 2019) L_ + } Full Name (In BLOCK Letters), ae Employee No. Date of Birth Whether belong to Scheduled Caste Whether ‘Person with Disability’ Cy Scheduled Tribe __| Nature of Handicap (Please). opc Indicate % of disability within ( ) below If, OBC, Entry No in Central ist VRC] ] fo | [omnes If SC/ST/OBC, name of the Caste/ Tribe Domicile —____] Address of Correspondence ‘Mobile No Land tine with | STD Code Email id _|Employment details in JOCL | At the time of joining ‘Current Status Date of Joining Grade & Grade & Designation | Date in Current | Place of Posting | Designation Graie | | Please provide Details of educational quali 5 the format provided at page 3 7 Declaration Thereby declare that: 8) The qualification acquired by me is recognized by the appropriate authorities. I will produce the letter of recognition, in case of requirement. b) Thave not been awarded any major penalty during my service period in IndianOil Thereby certify that the above information is true to the best of my knowledge and I understand that my candidature shall be cancelled if the information is found to be false or incorrect, {also understand that the Management has the right to post me at any Location/Division upon my selection to the Officer grade. Date: Place: (Signature of Employee) List of attachments i. Self attested copies of mark-sheets ofall semesters and degree/ diploma certificates Copy of permission letter issued from IOCL to pursue the studies leading to acquiring the eligible qualification (if any) Caste certificate/ disability certificate (wherever applicable) iv. Any other relevant document, For Office Use Verification by HR Dept |. The particulars furnished by the applicant have been verified and found in order Tl. The applicant has not been awarded any major penalty during his service period with IOCL IIL The applicant is not undergoing any disciplinary action as on date The applicant fulfills the eligibility criteria of selection of departmental candidates to officer grade under Accelerated Career Progression Scheme (ACPS) revised in 2013 and clarification ireced thereafter. (Signature of HR Officer) Date: Name: Designation: Emp No: Unit/ Location:ee ‘sadojdurg yo anjeudig WopwUd\soq IIA 129450 Bupsoday jo owe sadojdurg Jo aanpeusig UU sourpoduy jeuoHEN Jo onyASUT (a (19 aoueuny /9d'1 S218 “214 0} payoeyyE suonsuny ay) Ayoads aseayq) Paudysse soynp Jo armyeu pue usuyavdog [euoysuny | Yorstatq Bupoye YA! Woy sayEpypuTd 104 {uo afquoyddy AUSIOATD sea (p Aysioatuy pouroq (9 Aysioatup mauusrog (4 aimnsuy ouoye pug (e Morea x04 srexdoadde uy sp, Supyavur dq aampsuy /Ays1964N7 ano4 Jo uoRENYE ounyeU aM WLAUOD aseorg youvos aqwopesy I | Jouway, uopodaros | HOssHUpE ‘aanyysuy souspuodsais0> | asin03 Jo Mysi9aquy 943 JoowEN | jewp-aeE IN| woneING wonezEpads Apueag, aaitop | Joowey Aimo (9 YMOUVO /a IWIN Ut Yd /VEIWANE[EAInbo 40 We oN eaKoydung a | Od MPL ata puayeambo 10 TY ) wexy aaafog Budmqend jo sirmaq_ roureN,