1. Application Form against Advertisement dated 20-26th
Dec’2014
* POST APPLIED FOR ____________________________________________________
Fields marked * are mandatory
1. Personal Details
* Name of the Candidate : ____________________________ * Father’s / Husband Name : _________________________
(Full name as appear in Class Xth Certificate)
Gender (Male / Female) : ____________________________ * Date of Birth (dd/mm/yy)
: _________________________
(Attach copy of Class Xth Certificate with hard copy of Application Form)
* Category
:
_____________________________ * Whether belong to Minority : _________________________
(Gen. / SC / ST / OBC / PwD-Person with Disability) (Yes / No)
(Attach copy of Caste Certificate in case belongs to reserved category with hard copy of Application
Form)
* Whether applicant is
Ex-Serviceman (Yes / No)
: _____________________________
Marital Status
(Single / Married)
: _________________________
Landline No. : _____________________________ Mobile No. : _________________________
(with STD code)
*
*
E-Mail
Current Residential
Address
:
:
_____________________________
_____________________________
_____________________________
_____________________________
* Permanent Residential
Address
:
__________________________
__________________________
__________________________
__________________________
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Paste a Self‐ attested
passport size
photograph here

2. 2. Education Qualification (starting from 10th
onward):
Examination Passed Full Degree Name
(for Graduation and onwards)
Name of the Board / University
/ Institute
Year of
Passing
Whether Regular / Part-
Time / Distance
Percentage
obtained
* 10th
* 12th
* Graduation
(B.A., B.Com, B.Sc etc.)
Post-Graduation
(M.A., M.COM, M.Sc etc.)
Use extra sheets, if required. Attach copies of all mark sheets, certificates duly self-attested with hard copy of Printed Application Form.
3. Professional Qualification:
Full Name of Degree / Course Name of the University /
Institute
College Name Duration
of the
Course in
Years
Year of
Passing
Whether
Regular/
Part Time /
Distance
Specialization /
Discipline
Percentage
/ Grade
obtained
Use extra sheets, if required. Attach copies of all mark sheets, certificates duly self‐attested with hard copy of Printed Application Form.
4. Additional Qualification/Training attended (if any):
S.No. Full Name of Qualification / Training Duration Details (in brief)
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3. 5. Details of complete experience starting from the present employer:
(only after Graduation Experience has to be mentioned)
S.No. Name of Employer Position
held
Executive
or Non-
Executive
Duration of Position held Job Profile (in brief) Gross Salary
p.m.
(in Rs.)
From Date To Date
Use extra sheets, if required. Attach copies of all experience certificates duly self-attested with hard copy of Printed Application Form.
6. If presently working with Government / Semi-Govternment / PSUs/Banks / Local Bodies etc., please give Name & Address of HR
Head / Personnel Department.
Name & Address of the HR Head / Personnel Deptt. : ________________________________________________________
_________________________________________________________
7. Have you ever appeared in interview for any post in NSIC during last 3 years? : Yes _____ / No _____
In case Yes, provide the following details:
Name of the post : ________________________ Year of interview : ________________________
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4. 8. References with complete Name, Address, Telephone, Mobile Numbers:
(1) Reference No.1:________________________________ (2) Reference No.2:________________________________
________________________________ ________________________________
________________________________ ________________________________
Place: ____________________________________
Date: ______________
Self-Declaration of applicant:
Yes
(a) I have verified the above details, and the details are in order to the best of my knowledge & belief.
(b) I understand that merely filling this Application Form will not be treated a complete application. Therefore, I further declare that I will send this
Application Form with self-attested photo pasted at appropriate place, copies of all self-attested certificates of caste/disability/work experiences/
qualification to DGM(HR), NSIC Ltd. so that the same is received on or before 13.1.2015.
Signature of Applicant
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