Application format for the post of Peon
(To be filled in capital letters) Space for self
attested recent
1. Name of the Applicant : __________________________________
photo
2. Father / Husband Name : __________________________________
3. Date of Birth : __________________________________
4. Gender : __________________________________
5. Marital Status : __________________________________
6. Category : __________________________________
7. Sub-Category : __________________________________
8. Employment Exchange : _________________________________________________
9. Registration No. and Date : __________________________________________________
10. Educational Qualification :
Examination Name of the Subjects Marks Percentage Year of
Board/ Obtained/Total Passing
University Marks
Matric
11. Permanent Address : __________________________________________________
__________________________________________________
__________________________________________________
____________________________Pin Code_____________
12. Correspondence Address : __________________________________________________
__________________________________________________
__________________________________________________
____________________________Pin Code_____________
13. Aadhar Number : __________________________________________________
14. Email ID : __________________________________________________
15. Mobile Number : __________________________________________________
16. Documents Attached with Write yes or no for documents attached.
(a) Matriculation ____________________________________________
(b) Himachali Bonafide Certificate ___________________________________________
(c) Employment Registration Certificate __________________________________________
(d) Detail of fees: IPO/DD No. ________________ _________________
Dated ________ Payable at _____________________
Note:-Attested/self attested copies of date of birth certificate, academic qualification certificate,
SC/OBC certificate and bonafide Himachali certificate, Backward Area/Panchayat certificate,
landless family/family having less than 1 hectare land certificate ,non –employment /BPL
certificate, widow/divorced/destitute/single woman certificate, single daughter/orphan certificate,
differently abled person certificate, NCC/NSS/Scouts & Guides Certificate and Certificate of
experience, as the case may be, must be attached with this application.
Duly filled self evaluation form should be attached with application.
Declaration
I…………………………the above named candidate solemnly affirm and declare
(a) That the information filled in the application form is true and correct to the best of my
knowledge and belief.
(b) That I understand that any willful mis-representation of facts or concealment of information
shall result in the cancellation of candidature and liable to legal proceedings.
(c) That I have never been dismissed either from Government/Semi Govt./other Public or Private
organization service.
(d) That I have never been arrested/prosecuted or involved in any criminal case or convicted by a
Court of Law (If otherwise, please details separately).
Date : Signature of the candidate
Place :
Evaluation Form
Evaluation of 100 Marks for the post of Peon in the Kangra Co-op. Primary Agri. & Rural
Development Bank Ltd. Dharamshala
(To be filled by candidate)
Sr. Detail of Criteria of 100 Marks Marks Marks
No. claimed
by
candidate
1. Percentage of marks obtained in qualifying examination to be 85(Eighty
calculated out of 85. (For example a candidate getting 50% Five)
marks in metric will be given 42.5 marks)
2. Belonging to notified Backward Area or Panchayat as the case 1 (One)
may be.
3. Land less family/family having land less than One Hectare to be 2 (Two)
certified by the concerned Revenue Authority.
4. Non-employment Certificate to the effect that none of the family 2.5 (Two &
members is in Government/Semi- Government. half)
5. Differently abled persons with more than 40% 1 (One)
impairment/disability/infirmity.
6. NSS (At least one year) certificate holders in NCC/The Bharat 1 (One)
Scout and Guide. Medal winner in National level sports
competitions.
7. BPL family having family annual income (from all sources) 2.5 (Two &
below ₹ 40,000 or as prescribed by the Govt. from time to time half)
8. Widow/divorced/destitute/Single 1.5 (One &
women half)
9. Single daughter/Orphan. 1 (One)
10. Experience up to a maximum of 5 years in Govt./Semi-Govt. 2.5 (Two &
Organization relating to the post applied for (0.5 marks only for half)
each completed year.)
Total 100
Note :- Wherever marks are claimed, candidate is required to attach attested/self attested copy of
marksheet/certificate and to show the original to Bank when called to do so.
Encls:-
1 ………………………………………… 2 ………………………………………………..
3 ………………………………………… 4 ………………………………………………..
5 ………………………………………… 6 ………………………………………………..
Signature of the candidate
Name ………………………………………….
Address ………………………………………..
