ANNEXURE-IV
APPLICATION FOR THE POST OF FACULTY/OFFICE ASSISTANT OF RSETI
ON CONTRACTUAL BASIS
To
Regional
Head/ Co-Chairman,DLRAC
Central
Bank of India,
Regional
Office Nasik,
P63,
Satpur MIDC,
Dist.
Nasik.
Pin
: 422007
With
reference to your advertisement on Bank’s Website dated _____________ I, submit
my application for the post of _________ in prescribed format as under:
1. |
Name (In Full) |
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2. |
Address For Correspondence |
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3. |
If Person With Disability: |
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Type Of Disability |
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Percentage Of Disability |
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4. |
Date Of Birth (As Per School Leaving Certificate) |
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Age In Completed Years As On ________ |
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5. |
Contact Details: |
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Mobile No. |
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Landline No. |
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E-Mail ID |
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6. |
Gender |
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7. |
Nationality |
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8. |
Religion |
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9. |
Marital Status |
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10. |
Father’s/ Husband’s Name |
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11. |
Permanent Address: |
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12. EDUCATIONAL QUALIFICATION:
Qualification |
Details (SSC/HSC (10+2)/B.A/ B. Sc. / M.A / M. Sc. Etc.) |
Board / University |
Full Time / Part-Time |
Year of Passing |
Subject |
Marks (Rank if any) |
SSC/HSC (10+2) |
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Graduation |
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Professional Qualification |
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Others |
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Computer (Diploma/Degree/ Certificate) |
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Note: Please attach copy of certificate duly attested by self or any
Gazetted officer.
13.
For Faculty only:
A.
RELATIVE EXPERIENCE (if any)
_________ Total (in years) ________________.
Sr. No. |
Institution |
Designation |
Duration From To |
Responsibilities |
Achievements |
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B.
For retired Officials:
Retired on VRS/ superannuation |
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Name of the organization from which
retired |
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Date of retirement |
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Total years of service |
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Years. |
Out of which as an officer in
organization/ rural development institution/ faculty in training centre. |
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Years. |
No. Of years worked as rural branch
managers/ field officer in case of bank’s services. |
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Years. |
Date of issue of service certificate
of previous employer |
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Note: Attach self-attested copy of service certificate of
previous employer/ experience of Faculty, Rural Development from organization/ institutions
concerned.
14. |
Details of Present Employment |
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(a) |
Organization |
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(b) |
Full Address |
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(c) |
Position |
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(d) |
Reporting to |
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(e) |
Salary / Compensation Presently drawn |
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15. |
Brief details of experience in the Bank/other institution in
respect of working in Rural Area as Rural Development In-Charge / Bank
Official and Faculty in training centre. (for faculty only) |
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16. |
Significant Achievement (if any) in respect of above assignments
(for faculty only): |
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17. |
Name & Address of two references: |
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(1) |
(2) |
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DECLARATION:
I
hereby declare that the particulars furnished above are true and correct to the
best of knowledge and belief and I understand that in the event of any
information being found false or incorrect at any stage or not satisfying the
eligibility criteria according to the requirements of the relative
advertisement, my candidature/ appointment for the said post is liable to be
cancelled/ terminated at any stage and if appointed, my service are liable to
be terminated.
I
hereby agree that any legal proceedings in respect of any matter of claims or
disputes arising out of this application and/ or out of said advertisement can
be instituted by me only at Mumbai and Courts/ Tribunals/ Forums at Mumbai and undertake to abide by all the terms
and conditions mentioned in the advertisement displayed on Bank’s website dated
____________.
____________________
(Signature
of applicant)
Place:
__________________________.
Date:
__________________________
Enclosures:
1.
2.
3.
4.
5.