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Bihar Kshetriya Gramin bank

Recruitment Project-2009-10Application for the post of Clerk-cum-Cashier

(Fill all columns in legible capital letters in his/ her own hand writing and use 8.27 x 11.69 size paper- A4 size).

Information in first five columns viz. Post, name, fathers Name, Address for communication and Permanent address must be

filled in ENGLISH ONLY

To,Bihar Kshetriya Gramin Bank

Clerical Recruitment Project-2009-10,

Post Box No.7641

Malad (West)

MUMBAI-400 064

(Delete whichever is not applicable)Dear Sir,

With reference t Bihar Kshetriya Gramin Bank advertisement, I submit my application in the prescribed format:-

1. FULL NAME IN BLOCK LETTERS:

(Leave one space blank between two parts of your name)

2. FATHERS/ HUSBANDS NAME IN BLOCK LETTERS:(Leave one space blank between two parts of name)

3. ADDRESS FOR COMMUNICATION (In Block Letters)

4. PERMANENT ADDRESS (In Block Letters)

5. Telephone No with STD Code:

Cell No:

E-mail address:

6. Gender (Please indicate by putting in the appropriate BOX)Male Female

7. Category to which you belong (Please indicate by putting in the appropriate BOX)SC ST OBC GENERAL

(Please attach attested Photostat copy of Caste Certificate of SC/ ST/ OBC as applicable, in the format prescribed by Govt

of India)

a. Religion:Sub-caste:

b. Name of the State/ UT to which you belong:.c. If Person with Disability

(Please indicate by putting in the appropriate BOX)

OrthopaedicallyHandicaped(OH)

Hearing Impaired(HI) Visually Handicapped(VH)

PIN

PIN

Paste your recent

size photograph and

sign it across.Please retain with

you three copies of

the same photo for

subsequent use

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Percentage of Disability:.

(Please attach attested Photostat copy of medical certificate issued by Competent Authority)d. Are you eligible and intend to use the Service of Scribe?

(Please indicate by putting in the appropriate BOX)

Yes No

e. Do you belong to Religious Minority:

Yes No

8. (a) Date of birth (As per School Leaving Certificate SSC/ SSLC)

Date Month Year

(b) Age as on 01.02.2010:.YearsMonths

( c) relaxation in Age (if claimed): No of Yearsunder category

9. Nationality:.

10. Details of Application fees and Postage charges:

Name & address

of issuing Bank/

Branch

Name & Address of

Drawee Bank/

Branch

Date of issue Demand Draft/

Bankers Cheque

No.

Amount in Rs.

(Application Fee should be sent in the form of Demand Draft in favour of Bihar Kshetriya Gramin Bank Clerical

Recruitment Project 2009-10 payable at Munger (Bihar). Fees for General and OBC candidates is Rs.300 and for SC/

ST/ PWD/ EXS candidates is Rs.50)11. Pre-Examination Training (To be filled in only by those SC/ ST/ PWD/ Religious Minarity Community candidates, who

are desirous of taking Pre-Examination Training)

Are you desirous of taking pr-examination training?

(Please indicate by putting in the appropriate BOX)

Yes No

12. Place of Birth: Town/ Village..Tehsil:

District.State:..

13. Are you an Ex-serviceman?

Yes No

If yes, specify the following

i) Date of Discharge:.

ii) Rank at present/ last held:.

a) Acting as:.w.e.fb) Substantive: w.e.f..

14. Are you divorced/ Judicially separated?

Yes No

15. Are you a candidate who had originally been domiciled in Kashmir Division of the state of J & K during the period of01.01.1980 to 31.12.89

Yes No

16. Educational Qualification (From Class X onwards) (As on 01.02.2010)

Examination

Passed

Name of the

board/

University

Subjects

Studied

Month &

Year of

passing

% of

Mark

s

Class/

Division

10th Std

12th Std

Graduation

Post

Graduation

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Others

(If space is not sufficient please attach separate sheet)

17. Languages known. (Please indicate by putting in the appropriate BOX)S.No Language Read Write Speak

18. Particulars of Post Qualification Experience including the Present Occupation/ Job.

Name of the

employer(s)

firm etc and thenature and

details of

activities

carried out bythe employer

Designation and

rank if any

Period of

service

Length

of

serviceYears,

Months

, Days

Nature of

duties

performedin detail

Remarks

(Reasons

forleaving

service)

From To

19. Are you a native/ domicile of Bihar? If yes, attach copy of domicile certificate.

Yes No

20. Center of Written Examination (IN BLOCK LETTERS)

CENTER CODE

21. Any other information:

22. Before mailing application please check that you have furnished the following:

a) Category/ Sub-category and have enclosed copies of necessary certificates for SC/ ST/ OBC/ PWD/ EXS candidates.b) Details regarding fees (Bank Demand Draft/ Bankers Cheque)

c) Address for communication:

d) Details for claiming relaxation in age and the relevant certificate is enclosed.

e) Two self-addressed unstamped envelopes of 11x5 size.

f) An attested copy of Domicile Certificate is enclosed.g) The envelope is to be super scribed with the words APPLICATION FOR THE POST OF CLERK-CUM-CASHIER,

Bihar Kshetriya Gramin bank Clerical recruitment Project-2009-10

DECLARATION

I hereby declare that all the statements made in this application are true, complete and correct to the best of my knowledgeand belief. 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/ reject at any stage and if appointed, my services are liable to be cancelled/ terminated. I have not beendebarred from taking up the test/ selection by any Bank/ IBPS and I have not been convicted in any criminal case. I am

willing to serve anywhere, if selected. I agree that the bank has the right to transfer me to any place at its discretion.I hereby agree that any legal proceedings in respect of any matter(s) or claims or disputes arising out of this application and/

or out of the said advertisement can be instituted by me only before the Courts/ Tribunals/ Forums at Munger and they also

shall have the sole and exclusive-jurisdiction to try any case/ dispute. I undertake to abide by all the terms 7 conditions

mentioned in the advertisement given by the Bank and other further communication/ intimation/ notification with regard to

this recruitment.

Place:

Date: Signature of the Applicant