Application Format

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APPLICATION - PROFORMA

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Post Applied For : __________________________________
Photograph

(All annexures /enclosures should be sequentially arranged with page numbers and self-attestation
of the candidate)

1. General Information of the Applicant:


Full Name in Capital Letters
(as per the official certificate)
TARUN KUMAR
Father’s/ Husband’s Name SUSHIL KUMAR
Date of Birth (DD/MM/YYYY) 30/03/1995
Age (as on the last date of application submission) 29 years/10 Months
(YY/MM)
Place of Birth Ganaur/ Haryana
Religion
Gender (Tick the relevant option) Male/ Female/ Transgender
Marital Status (Tick the relevant option) Single/ Married
1.
Contact No. / Mobile No.
2.
1.
Email ID
2.
Category (Tick the relevant option) SC/ ST/OBC/Unreserved

Special Category (Tick the relevant option) PwD/ EWS/ Ex-Serviceman


Do you possess the essential educational qualifications
Yes/ No
& experience as mentioned in the advertisement?

Present Address

Permanent Address
CCRT, New Delhi

2. Present Employment:
Designation

Organization & Address

Roles and Responsibilities

Present Basic Pay, Pay Scale& Gross


Emoluments/Month

Date of Appointment to the Present Post


Total experience in the current position as on the
last date of application submission (YY/MM)

3. Educational/Other Professional Qualifications (Starting with the highest qualification


upto SSLC)

Examination Division/ Grade/ Duration of


Sl. Board/ University/
Passed and Year Percentage of the Degree/ Subjects
No. Institution
of Passing Marks Diploma

01

02

03

04

05

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CCRT, New Delhi

4. Details of Employment in Chronological Order (Attach certificate(s) of employment)


Name of the Duration
Ad-hoc/ Total
Organization/ Post Held Salary Nature of Duties
Regular From To Period
Institute/ Firm

5. Any Other Relevant Information (Attach extra sheet, if required):

6. Details of Two References:


S. Post Held by the Postal Address with Phone/ Mobile No.
Name of the Referee
No. Referee and Email

1.

2.

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CCRT, New Delhi

7. Character & Antecedent Reports


S. No. Subject Remarks
1 Have you ever been subjected to any disciplinary action,
as a student and/or as an employee? If so, give the
complete details
2 Have you ever been dismissed/ suspended from
service/employment? If so, give the complete details
Were you involved in any criminal case? If so, give the
3
complete details
4 Is any case (criminal case/ disciplinary action) pending
against you in the Court? If so, give the complete details

8. Demand Draft Details:


Demand Draft No. Date Amount Name of the Bank & Address

9. Checklist for Enclosures:


S. Please put No. of
Document
No. Tick Mark Sheets
1 SSLC Mark Sheet Yes/No
2 HSC Mark Sheet Yes/ No
3 UG Mark Sheets Yes/No
4 UG Degree Certificate Yes/ No
5 PG Mark Sheets Yes/ No
6 PG Degree Certificate Yes/ No
7 Equivalence Certificate in case of Foreign Degrees Yes/ No
8 Community Certificate Yes/ No
9 Disability Certificate (if applicable) Yes/ No
10 Experience Certificate(s) Yes/ No
11 NOC from the Present Employer Yes/ No
12 Latest OBC Certificate (if applicable) Yes/ No
13 Documents of any Pending Cases, Disciplinary Action etc. Yes/ No
14 Photo Identity Card (Aadhar/PAN/ Driving License) Yes/ No
Photographs (One photograph to be pasted in the application and Two Yes/ No
15
nos. of recent photographs are to be enclosed separately)
16 Any Other Documents in support of the Post Applied Yes/ No
17 Demand Draft Yes/ No

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CCRT, New Delhi

UNDERTAKING

I declare and fully understand that in the event of any information furnished in this application being

found to be false, misleading or in correct at any stage, my application/candidature is liable to be

summarily rejected and if I am already appointed, my services are liable to be terminated without

any notice as per the Act/Statutes, etc., and other applicable rules of Government of India. I also

hereby declare that I have never been convicted for any offences and there are no criminal/

departmental proceedings pending/ contemplated against me.

Place: (Signature of the Applicant)

Date:

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