284

THE ASSAM GAZETTE, APRIL 12, 2017 PART II A.]

The 9th February, 2017

CORRIGENDUM

No. ASE. 333/2010/Vol-I/230. - Please read as "Smti. A. D. Bharali" instead of "Smti. S. D.

Bharali" as appears in Sl. No. 7 of Govt. Notification No. 333/2010/Vol-I/225, dated 21st January,

2017.

The 15th February, 2017

No. PDA. 395/2008/63. -

The 15th February, 2017

No. JDJ. 202/2006/392. -

No. JDJ. 204/2006/Pt./15. -

Joint Secretary to the Government of Assam,

Secondary Education Department.

Addl. Secretary to the Government of Assam,

Panchayat and Rural Development Department.

P. SAIKIA,

Secretary to the Government of Assam,

Judicial Department.

PART II A. ]

THE ASSAM GAZETTE, APRIL 12, 2017 285

The 16th February, 2017

CORRIGENDUM

No. GLR. 322/95/115. - Please read the period of sanction as "with effect from

01-07-2014 to 28-02- 2015 (8 moths)" instead of "01-03-2014 to 28-02-2015 (8 months)" which

appears in the subject and the body of the sanction letter No. GLR. 322/95/114, dated 13th

February 2017.

The 22nd February, 2017

No. DTK/RL/2017/675. -

The 20th February, 2017

No. GLR. 224/07/52. -

District Transport Officer,

(Registration and Licencing)

Kamrup (M), Betkuchi, Guwahati-34.

RUPESWAR PATAR,

Deputy Secretary to the Government of Assam,

Labour and Welfare Department.

A. K. BHATTACHARYYA,

Under Secretary to the Government of Assam,

Labour and Employment Department.

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The Assam Gazette

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PUBLISHED BY THE AUTHORITY

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No. 15 Dispur, Wednesday, 12th April, 2017, 22nd Chaitra, 1939 (S.E.)

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Separate paging is given to this Part in order that it may be filed as a separate compilation.

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PART IX

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Advertisement and Notices by Government Offices and Public Bodies.

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STANDARD APPLICATION FORM

Post applied for ...........................................................................................................................

INSTRUCTIONS

While filling up the Application Form, applicants are requested to note the following:

This application is a key part of the selection process.

Fill each and every part of the Form carefully and completely. In case

any clause in the form is not applicable in your case, please write

"Not Applicable" in the space provided. Incomplete applications

will be rejected.

Please enclose self attested copies of mark-sheets of all Board/

University examinations, Permanent Residence Certificate,

Employment Exchange Registration Card etc.

The LAST DATE of submission should be strictly adhered to.

Paste your

passport size

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photograph and

affix your

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photograph

194

THE ASSAM GAZETTE, APRIL 12, 2017 [ PART IX

FILL IN CAPITAL LETTERS ONLY

01. Name of Candidate (as recorded in Matriculation or Equivalent Certificate)

02. Date of Birth (as recorded in Matriculation or Equivalent Certificate)

DATE

MONTH

YEAR

02. (A) Place of Birth

02. (B) Nationality

03. Sex:

Male

Female

04. Father's Name:

05. Father's Occupation, Designation and Address

06. Mother's Name:

07. Mother's Occupation, Designation and address

08. Husband's Name: (if applicable)

09· Husband's Occupation, Designation and Address

10. Place of Birth

a) Village / Town

b) Police Station

c) District

d) State

11. (A) State your Religion

11. (B) Are you a member of Schedul Caste/Schedul Tribes (Answer 'Yes' or 'No'). If yes, give

particulars supported by a Certificate copy which should be enclosed.

12. Educational Qualifications (HSLC/SSC Onwards:

Exam or name School/College

Board/

Year of

Class Major

% of

of the

with Address

council/

passing

/ Div.

Subjects

marks

equivalent

University

exam

Matriculation

Higher

Secondary

(Science)

Degree

13. Any Other Qualification (NCC, NSS etc) :

14. Experience: (Please give details thereof)

Name of the

Designation

Period

Scale of Pay

Organisation

To From

15. Language known:

a) Spoken

b) Written

16. Mother Tongue:

17. Employment Exchange Registration No. (Provide photocopy of Registration Card)

18. Address for correspondence:

P I N C O D E

19. Permanent address of Applicant:

P I N C O D E

20. E-mail id if any:

21. Telephone number (s) if any:

22. Mobile number (s) if any:

23. Distinction/Award/Special

Achievements/Extra

Curricular

Activities/Experience:

(Attach a separate sheet if required)

DECLARATION

I declare that I fulfil all the conditions of eligibility regarding age limits, educational

qualification etc. prescribed for the recruitment.

I have enclosed self attested photocopies of certificates in support of my claim for

Educational Qualifications, Age, Category (SC/ST/OBC/General) and Age relaxation etc.

I hereby further 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 suppressed/false or incorrect or

ineligibility being detected before or after the recruitment, my candidature/appointment is liable to be

cancelled forthwith.

Place:

Date:

Signature of the candidate

PART IX.]

THE ASSAM GAZETTE, APRIL 12, 2017

195