Whether Willing To Be Considered For The Post of Corporate Insurance Executive (Mark "X" in The Appropriate Box) YES NO

J & K GRAMEEN BANK Paste your
RECRUITMENT PROJECT-2010 recent passport

APPLICATION FORMAT photograph and
(Fill all columns in capital letters and use 21 Cms. x 34 Cms. size paper) sign it across
To,
J & K GRAMEEN BANK RECRUITMENT PROJECT 2010
With reference to your advertisement in ……………………………….. dated ____________ submit my

application in the prescribed format.
1. FULL NAME (IN BLOCK LETTERS) (leave one space blank between two parts of your
name).
2. ADDRESS FOR CORRESPONDENCE: (IN BLOCK LETTERS)
3. CENTRE OF WRITTEN EXAMINATION___________ (IN BLOCK LETERS):

4. POST FOR WHICH APPLIED: _________________, POST CODE____________________
Whether willing to be considered for the Post of Corporate Insurance Executive (Mark
"X" In the appropriate Box)
YES NO
5. Indicate Category to which you belong to by marking "X" in the appropriate box.
SC ST OBC GEN
(Please attach attested copy of certificate wherever necessary)

6. (a). Date of Birth (As per School leaving Certificate SSC/SSLC)
Date Month Year
Age (as on 01.04.2010) : _______ Year _________ Months.
(b). Are you seeking age relaxation ?
YES NO
If YES, provide the details
-------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------
7. Details of Application fees:

Name and address of the Name and address of the Date of DD/Bank pay Amount
issuing Bank drawee Bank Issue order No. (Rs.)
(Fee for the post is Rs. 500/- for General Candidate including OBC and Rs. 100/- for
SC/ST/PWD/XS candidates). Payment by Cash, Cheque, Postal Stamps, Money Order,
etc. will not be accepted and such applications will be rejected.
8. YOUR CONTACT TELEPHONE NO. (with STD code) _______________
FAX _____________ E-Mail _______________ MOBILE NO. ______________
9. (i) GENDER : (Mark "X" In the appropriate Box)

MALE FEMALE
(ii) a) Are you an Ex-Serviceman ? (Mark "X" In the appropriate Box)

YES NO
b) In case of Ex-Serviceman/Commissioned Officer/Other Equivalents,
specify.
Date of Discharge __________________
Rank at present/last held.
A) Acting__________________ w.e.f. _______________________
B) Substantive ______________ w.e.f. _______________________
(iii) Are you a Person with Disabilty ?

(Mark "X" In the appropriate Box)
YES NO
If yes, then percentage ______ and type of disability __________________
(attach the certificate)
(iv) Do you intend to use the services of a Scribe (Mark ‘X’ in the appropriate box)
YES NO
(v) In case of SC/ST/OBC Candidate :

Name of Caste/Tribe/Class : _______________________________
(vi) Are you serving in RRB ? (Mark ‘X’ in the appropriate box)
YES NO
(vii) Are you a domicile of J & K ? (Mark ‘X’ in the appropriate box)
YES NO
10. FATHER’S/HUSBAND'S NAME (IN BLOCK LETTERS)
11. NATIONALITY : _______________________________
12. PLACE OF BIRTH :

Place:__________ Dist.:________________ State: ___________________
13. PERMANENT ADDRESS (IN BLOCK LETTERS) :
P I N
(Please attach attested copy of nativity certificate)
14. Educational and Professional Qualifications:
Details of Educational qualification (10th standard onwards)
Examination Name of the Subjects Date Month, Percentage of Class/
Passed Institution/ University studied in year of aggregate Division
detail passing marks
(If space is not sufficient please attach separate sheet)

15. Particular of Post Qualification Experience including the Present Occupation/Job
(As on the date of application) :
Name of the employer (s) Designation Period of Length of Nature of Remarks
firms etc. and the nature and and rank if service service duties (Reasons)
details of activities carried any Years, performed for
out by the employer Months, in detail leaving
Days service)
From To
16. Languages known:

S.N. Language Read* Write* Speak*
(* Mark "X" In the appropriate Box)

17. BEFORE MAILING APPLICATION PLEASE CHECK THAT YOU HAVE CORRECTLY
MENTIONED:
a) The center where you wish to appear at.
b) Category/Sub Category and have enclosed copies of necessary certificates for
SC/ST/OBC/PC/XS candidates.
c) Details regarding fees (Bank demand draft/Bank pay order)
d) Address for correspondence.
e) Application form with requisite fee is sent.
f) Details for claiming relaxation in age and the relevant certificate is enclosed.
g) Domicile Certificate is enclosed.
Signatures of the candidate

DECLARATION
I hereby declare that all statements made in this application are true, complete and 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 am willing to serve anywhere in J & K. I agree that the Bank has the
right to transfer me to any of the branch/office. I agree that any legal proceedings in respect of
any matter (s) claims or disputes arising out of this application and/or out of said
advertisement can be Instituted by me only at Courts/ Tribunals/Forums at JAMMU or
SRINAGAR only shall have sole and exclusive jurisdiction to try the cause/dispute. I undertake
to abide by all the terms and conditions mentioned in the advertisement No. _______________dated
______________.
Place : -------------------
Date : -------------------- SIGNATURE OF

Whether Willing To Be Considered For The Post of Corporate Insurance Executive (Mark "X" in The Appropriate Box) YES NO

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Whether Willing To Be Considered For The Post of Corporate Insurance Executive (Mark "X" in The Appropriate Box) YES NO

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J & K GRAMEEN BANK Paste your

RECRUITMENT PROJECT-2010 recent passport

With reference to your advertisement in ……………………………….. dated ____________ submit my

2. ADDRESS FOR CORRESPONDENCE: (IN BLOCK LETTERS)

3. CENTRE OF WRITTEN EXAMINATION___________ (IN BLOCK LETERS):

(Please attach attested copy of certificate wherever necessary)

7. Details of Application fees:

9. (i) GENDER : (Mark "X" In the appropriate Box)

(ii) a) Are you an Ex-Serviceman ? (Mark "X" In the appropriate Box)

(iii) Are you a Person with Disabilty ?

(v) In case of SC/ST/OBC Candidate :

10. FATHER’S/HUSBAND'S NAME (IN BLOCK LETTERS)

11. NATIONALITY : _______________________________

12. PLACE OF BIRTH :

13. PERMANENT ADDRESS (IN BLOCK LETTERS) :

(If space is not sufficient please attach separate sheet)

16. Languages known:

(* Mark "X" In the appropriate Box)

Signatures of the candidate

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