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http://dte.up.nic.in
APPLICATION FORM FOR GOVT.OFFICERS
[THROUGH PROPER CHANNEL]
(Note :Any column left blank will make the application incomplete and liable for rejection)
1. Name of the post applied for:
_______________________________________________
2. (a) Name: _________________________________________________________________
(b) Identification Number (For Defence Service personnel)_ _______________________
(c) Designation of the Applicant(in full) : ________________________________________
(d) Office Address : ____________________________________________________________
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3. Address for communication : __________________________________________________________
4. Telephone No. : Office Residence _________________________ Fax No._____________________
Mobile No.__________________
E-Mail address______________________________
5 Date of Birth______________________
Age as on date of vacancy : ____________
6 Eligibility criteria:
As per job description
Possessed by the officer
Whether
eligible or not
Educational/professional
qualification(along with the
name of Institutions)
Pay Scale
Length of service in eligible
pay scale
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7. Do you hold lien in any other organization?
Yes
No
If yes:
a) Name of the organization in which the lien is held.
b) the date from which the lien is held
Are you on deputation?
Yes No
If yes:
Date from which you have been on deputation
Yes No
8. Whether any punishment awarded to the applicant during the last 10 years
If yes the details thereof
9. Whether any action or inquiry is going on against him as far as his knowledge goes.
If yes the details thereof
I certify that the details furnished by me in Cols. 1 to 9 are true and I am eligible for the post.
Yes
No
(Name and Signature of the applicant)
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I further submit my willingness that I will join the post, if selected. In case, If I give my unwillingness after the interview
is held , but before the appointment is processed or after issue of offer of appointment , I may be debarred for a period
of two years for being considered for a Board level post in any PSE other than the one to which I belong to.
Date:
(To be filled by the PSU/Ministry/Department concerned)
It is certified that the particulars furnished above have been scrutinized and found to be correct as per official records.
Signature & Designation of
the Competant Forwarding
Authority with Telephone no. & office Seal.
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