* Indicates Compulsory fields..

Application Form

Personal Details

*Post Applied

*Surname & Name:

(30 Chars)

*Father's Name:

(30 Chars)

*Identity Card Type:

*Identity Card Number:

(20 Chars)

*Gender:

Male

Female

* SSC/Equivalent

Regular

Private

To Claim Local Status please fill the following School Study details(Please refer Notification Page No: 6 ,Para No:20)

I to VII class study details

Basic Data

*Local/Non-Local:

Local

Non-Local

System Generated Based On Study Details for SSC Regular

*Native State:

*Native District :

*Caste:

Type of Candidate :

*Employee Code:

Please enter employee code

*Date of Birth:

Ex:(dd-MM-yyyy) No Age Bar For Internal Candidates.

*Date of Appointment:

Ex:(dd-MM-yyyy)

*Date entry into Present Grade:

Ex:(dd-MM-yyyy)

Work Place Address for Communication

*Designation:

(30 Chars)

*Grade:

(30 Chars)

*Mine/Dept:

(30 Chars)

*Area:

(30 Chars)

*State:

*Pin Code:

(ex:507101)

*Enter Your valid Mobile No.

Ex: 9478028019 (10 digits)

*Re-enter Mobile No.

(10 digits)

*Email Id:

ex:- hari@yahoo.com (max Chars 40)

Qualifications

Examination Passed	Prescribed Qualification	Subject	Name&Place of University/ Board (20 Chars)	% of Marks 00.00	Pass Year #	Time taken for completion of course (in Yrs)
Qualification	* Required	* Required	*Required	Required	* Required	* Required

Years of Relevant Experience :

Completed Years of experience.

Working in :

Name of the Employment Exchange :

Employment Registration No :

*Photo with Signature :

(10-50 KB)

Sample Image

*Place :

I declare that I have ensured my eligibility for the post applied against Circular No. CRP/PER/R/2024/1634 Dated 27.11.2024 and all the information furnished above is true/correct to best of my knowledge and records, I understand that if any information submitted by me is proved to be false at any stage, the decision of the Management will be final and binding on me including cancellation of my candidature and also I am liable for criminal prosecution. Further, I agree to abide by the rules, and regulations and the details mentioned in the Above Mentioned Circular kept in SCCL website.

Verified all the above furnished Data