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MSME Tech Centre Job Application

This document contains an application form for a post at the MSME Technology Centre Bengaluru. The form requests information such as the applicant's name, contact details, category, date of birth, gender, marital status, nationality, educational qualifications, past work experience, application fee details, languages known, and employment exchange registration number. The applicant is required to sign the form declaring that all information provided is true and agreeing that legal matters will be settled in the courts of Mumbai.

Uploaded by

Malavika Sivagurunathan
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172 views2 pages

MSME Tech Centre Job Application

This document contains an application form for a post at the MSME Technology Centre Bengaluru. The form requests information such as the applicant's name, contact details, category, date of birth, gender, marital status, nationality, educational qualifications, past work experience, application fee details, languages known, and employment exchange registration number. The applicant is required to sign the form declaring that all information provided is true and agreeing that legal matters will be settled in the courts of Mumbai.

Uploaded by

Malavika Sivagurunathan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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MSME TECHNOLOGY CENTRE BENGALURU

APPLICATION FORM
Paste here your
recent passport
size photograph
and sign it
1. Post applied for _____________________________________ across.

2. Full Name (Mr./Mrs./Kum.)


(USE CAPITAL LETTERS)
As it appears on your certificates (leave one space blank between two parts of your name)

3. Correspondence address (USE CAPITAL LETTERS)

Pin
Tel.No. (with STD Code) _______________________________
E-mail _______________________________

4. (a) Indicate category to which you belong by marking “  ” in appropriate box

SC ST OBC PH GEN

If SC/ST/OBC candidate, Caste __________________ State __________________________

(b) Are you a PH candidate ? YES / NO


If yes, please mention category of disability OH / HI / VI

(C) Are you an Ex-Serviceman? Yes No

(d) Are you a candidate who had ordinarily been domiciled Yes No
in Kashmir Division of the state of J&K during the period 01.01.1980 to 31.12.1989?

5. (a) Date of Birth


(as per SSC certificate) Date Month Year

(b) Age as on 01/08/2020


Years Months Days

6. Gender Male Female { Mark “  ” in appropriate box }

7. Marital Status Married Unmarried { Mark “  ” in appropriate box }

8. Nationality ______________________________________________________________________

9. Father’s/Husband’s Name

10. In case of Ex-Serviceman/Commissioned Officer/Police Officer/other equivalent, specify

i) Date of Discharge _______________________

ii) Rank at present/last held a) Acting ___________ w.e.f. __________


b) Substantive ___________ w.e.f. __________

11. Place of Birth: Place _______________ District ______________ State _______________

Cont....2
12. Educational & Professional Qualifications: Matriculation/SSLC onwards (as on 01.08.2020)
Examination Passed Name of the Subjects studied in Date, Month & %age of
Institution/ detail year of passing aggregate
University marks

13. Particulars of past experience including the present occupation/ job


(as on 01.08.2020)

Name of the Designation Period of Length of service Nature of Remarks


employer(s) etc. & service duties (reason for
the nature of performed in leaving
activities carried detail service)
out by them
From To Year months

14. Application Fee/Postal Charges Details

Name of the issuing Bank


Place of Issue
Demand Draft Number
MICR No.
Date of Issue
Amount
15. Languages known: (Mark “ ” in the appropriate box)
Sr. Language Read Write Speak
No.

16. Registration No., if registered with Employment Exchange: _________________

17. Any other information: _________________________________________________________________

I …………………………………………………………………………….hereby declare that all statements made


in this application are true, complete & correct to the best of my knowledge and belief. I understand
that in the event of any information being found false or incorrect at any stage or not satisfying the
eligibility criteria according to the requirements of the relative advertisement, my
candidature/appointment is liable to be cancelled/terminated. I hereby agree that any legal
proceedings in respect of any matter(s) or claims or disputes arising out of this application and/or out
of the said advertisement can be instituted by me only at Mumbai and Courts/Tribunals/Forums at
Mumbai only shall have sole and exclusive jurisdiction to try any cause/dispute. I undertake to abide
by all the terms and conditions in the advertisement given by IDEMI.

Place:

Date: Signature of the Candidate

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