GREATER CHENNAI CORPORATION, RIPON BUILDING, CHENNAI - 600 003.
APPLICATION FOR THE POST OF ASSISTANT ENGINEER
(MECHANICAL) / (CIVIL) / (ELECTRICAL)
APPLICATION FOR THE POST OF
Affixed Photo
1.Name in full (Block Letters) [ should be
attested by the
gazetted officer]
2.Fathers / Husbands Name
3.Gender Male Female Third Gender
(Tick the relevant box)
4.Maritual Status Married Unmarried
(Tick the relevant box)
5.Full Postal Address with Mobile No. & email-id
a) Permanent Address:
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Pincode:
District: Mobile No: email-id:
b) Address for correspondence
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Pincode:
District: Mobile No: email-id:
6.Nationality : Religion :
7. a) Date of Birth : b) Age :
D D/ M M/ Y Y Y Y
(Self attested copy of High School Certificate showing
Date of Birth must be enclosed)
8.a) Mother tongue :
(Please mentioned if Tamil is not mother tongue)
b) Second Language in School :
9.Category [SC(A)/SC/ST/MBC/BC/BC(M)/OC] :
(Self attested copy of Caste Certificate to be enclosed)
10.EDUCATIONAL QUALIFICATION
(Self attested copy of all Educational Qualifications to be enclosed)
Sl.No. Qualification Register No. Year of Marks, Grade Nam of the Institution
Passing obtained with class
Grade % Class
1. SSLC / MATRIC
2. HSC
11.PROFESSIONAL / TECHNICAL QUALIFICATION
(Self attested copy of Certificates as Proof)
Sl.No. Qualification Register No. Year of Marks, Grade Name of the Institution
Passing obtained with class
Grade % Class
1.
2.
12.If candidate belonging to Differently abled persons : (YES / NO)
Type of PH Percentage of PH Certificate No. Name of Issuing
and Date Medical Authority
13.OTHER DETAILS, IF ANY
Note : Stage of the case at the time of applying, Nature of the criminal charge, if acquitted on the date of this
application date of judgement should be given. (Tick the relevant box)
Section of Law
Pending Stage of Case YES NO
Acquitted YES NO
Date of Acquitted
D D M M Y Y Y Y
PARTICIPATION IN POLITICAL
In agitation YES NO
As member of Political YES NO
Organisation
Candidate in Election YES NO
Enclosures (Tick the relevant Column) to be attached
Sl.No. Documents Yes No Not applicable
1. Passport size photos (Colour) 1
2. Date of Birth (SSLC / Matric passed Certificates)
3. Educational Qualifications 10th
(Certificates & Marksheets)
HSC
Degree
4. Community Certificate
[SC(A)/SC/ST/MBC/BC/BC(M)/OC]
in prescribed proforma
5. No Objection Certificate (in case of Departmental
candidates)
6. Differently abled persons Certificate in prescribed
proforma for Employment in State Government
7. Discharge Certificate (in case of Ex-servicemen)
8. Whether all above documents / certificates are
self attested
Signature of the Candidate
DECLARATION
I hereby declare that all the statements made in this application are true and correct to the best of my
knowledge and belief. In the event of any information being found false / incorrect or ineligibility
deducted before or after the written test / certificate verification or even after appointment, my
candidature / appointment will stand automatically cancelled.
Signature of the Candidate
