ref.no.ecl/cmd/c-6/ rectt/18/766 dated : 10.12ecl)-u… · diwakar das 10357 fit 17.12.2018 14...

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ईटन कोलफस लमटेड (कोल इंडया का एक अंग) अय सह-बधक नदशक का कायालय, संटोरया, पो-#दशेरगढ़, िजला-वधमान, पि*चम बंगाल-713333 महाबंधक(का/औ.स.) का कायालय CIN-U10101WB1975GOI030295. फ़ ै स- 0341-2523586. EASTERN COALFIELDS LIMITED (A Subsidiary of Coal India Limited) Office of the Chairman-Cum-Managing Director, Sanctoria, PO: Dishergarh, Dist. Burdwan. West Bengal - 713333. Office of the General Manager (P&IR). CIN-U10101WB1975GOI030295. Telefax- 0341-2523586. Ref.No.ECL/CMD/C-6/ Rectt/18/766 Dated : 10.12.2018 Sub : Offer of appointment of Mining Sirdar T&S Gr.’C’, those who are found medically fit. The following candidates who are found successful in the written test for the post of Mining Sirdar in T&S Gr.’C’ & who had appeared for IME (Pre-employment Medical Examination) at Central Hospital Kalla & Central Hospital Sanctoria have been declared fit by the medical board for employment as Mining Sirdar in ECL. 2) The appointment letter of said candidates will be available with General Manager (P/Rect.), Recruitment Cell, Personnel Dept., ECL (HQ). In order to save time & postal delay candidates may collect their appointment letter in person during office hour in given dates against their name. 3) They have to bring (A) Indemnity Bond of Rs.100000/-(One Lakh) in Non-Judicial stamp paper from authorised stamp vender for specific purpose of executing service agreement Bond in favour of ECL to serve the company for a minimum period of 3(three) years and in case, he does not comply with the terms and conditions contained in offer of appointment he will have to deposit Rs. 100000/- in company. (B) They have to submit attestation form (3 sets), (C) Plural marriage declaration duly filled in the prescribed format which is enclosed with this notification along with (D) latest character certificate issued by Gazetted Officer / Head of the institute last studies. 4) The appointment will be subject to his testimonials, caste certificate competency certificate of Sirdarship / Overman found true/ verified. If it is revealed that any of these certificates furnished is found incorrect or false at any stage his appointment will be stand cancelled and he will be liable for legal action as per company rule. General Manager (P/Rect.)ECL Encl : 1. Format of Indemnity Bond 2. Attestation Form 3. Plural Marriage declaration Form.

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  • ई�टन� कोलफ��स �ल�मटेड (कोल इं�डया का एक अगं)

    अ�य� सह-�ब�धक �नद�शक का काया�लय,

    सं�टो रया, पो-#दशेरगढ़, िजला-वध�मान,

    पि*चम बगंाल-713333

    महा�बधंक(का/औ.स.) का काया�लय

    CIN-U10101WB1975GOI030295.

    फ़ै�स- 0341-2523586.

    EASTERN COALFIELDS LIMITED (A Subsidiary of Coal India Limited)

    Office of the Chairman-Cum-Managing Director,

    Sanctoria, PO: Dishergarh, Dist. Burdwan. West Bengal - 713333.

    Office of the General Manager (P&IR). CIN-U10101WB1975GOI030295.

    Telefax- 0341-2523586.

    Ref.No.ECL/CMD/C-6/ Rectt/18/766 Dated : 10.12.2018

    Sub : Offer of appointment of Mining Sirdar T&S Gr.’C’, those who are found medically fit.

    The following candidates who are found successful in the written test for the post of Mining Sirdar

    in T&S Gr.’C’ & who had appeared for IME (Pre-employment Medical Examination) at Central

    Hospital Kalla & Central Hospital Sanctoria have been declared fit by the medical board for

    employment as Mining Sirdar in ECL.

    2) The appointment letter of said candidates will be available with General Manager (P/Rect.),

    Recruitment Cell, Personnel Dept., ECL (HQ). In order to save time & postal delay candidates may

    collect their appointment letter in person during office hour in given dates against their name.

    3) They have to bring (A) Indemnity Bond of Rs.100000/-(One Lakh) in Non-Judicial stamp paper

    from authorised stamp vender for specific purpose of executing service agreement Bond in favour of

    ECL to serve the company for a minimum period of 3(three) years and in case, he does not comply

    with the terms and conditions contained in offer of appointment he will have to deposit Rs. 100000/-

    in company. (B) They have to submit attestation form (3 sets), (C) Plural marriage declaration duly

    filled in the prescribed format which is enclosed with this notification along with (D) latest character

    certificate issued by Gazetted Officer / Head of the institute last studies.

    4) The appointment will be subject to his testimonials, caste certificate competency certificate of

    Sirdarship / Overman found true/ verified. If it is revealed that any of these certificates furnished is

    found incorrect or false at any stage his appointment will be stand cancelled and he will be liable for

    legal action as per company rule.

    General Manager (P/Rect.)ECL

    Encl :

    1. Format of Indemnity Bond

    2. Attestation Form

    3. Plural Marriage declaration Form.

  • List of Candidates for receiving Offer of Appointment

    SL.

    NO.

    APPLICA-

    TION ID NAME FATHER'S NAME

    ROLL

    NO. IME

    REPORT

    Dt. for

    Receiving

    Offer of

    appointment

    1 1523464743 SUNNY KUMAR

    GUPTA

    UPENDRA

    PRASAD 10904 FIT 17.12.2018

    2 1523532210 MANOJ KUMAR

    MANDAL

    SHYAMLAL

    MANDAL 10464 FIT 17.12.2018

    3 1523269585 SUNIL KUMAR SHAKTI SAW 10898 FIT 17.12.2018

    4 1523427646 KARTIK KUMAR

    BIND MAHINDRA BIND 10386 FIT 17.12.2018

    5 1523787659 AKHILESH RAJ KUMAR 10033 FIT 17.12.2018

    6 1523267442 SUHAIL KAISER BADI UZ ZAMAN 10883 FIT 17.12.2018

    7 1523875515

    PRADEEP

    KUMAR

    MAHATO

    GANGADHAR

    MAHATO 10584 FIT 17.12.2018

    8 1523540438 PRAVEEN

    KUMAR

    JAY NARAYAN

    PRASAD 10601 FIT 17.12.2018

    9 1523431554 PURAN NAPIT RAJU NAPIT 10612 FIT 17.12.2018

    10 1523446340 RAJU KUMAR

    GUPTA SURAJ NATH SAW 10662 FIT 17.12.2018

    11 1523539601

    BASANT

    KUMAR

    MANDAL

    BIRENDRA

    MANDAL 10150 FIT 17.12.2018

    12 1524029978 ROHIT KUMAR MAN SHANKER

    RAO 10738 FIT 17.12.2018

    13 1523620277 JITENDRA

    KUMAR GUPTA DIWAKAR DAS 10357 FIT 17.12.2018

    14 1524022801 SHIV KUMAR

    SHARMA

    RAMSHAHI

    THAKUR 10836 FIT 17.12.2018

    15 1523357894 JAYDEEP

    KUMAR SHYAM PRASAD 10352 FIT 17.12.2018

    16 1523692173 GIRWAR

    KUMAR

    MOHAN LAL

    SAHU 10308 FIT 17.12.2018

  • 17 1523456613 AJEET KUMAR

    MANDAL

    KAILASH

    MANDAL 10026 FIT 17.12.2018

    18 1523771931 RAJENDRA

    PRASAD

    RAMCHANDRA

    SAW 10637 FIT 17.12.2018

    19 1523264349 MADHAW

    KUMAR RAJAK BIREN RAJAK 10438 FIT 17.12.2018

    20 1523443669 AJIT KUMAR

    CHOUDHARY

    BUDDHDEV

    CHOUDHARY 10028 FIT 17.12.2018

    21 1523890825 SANJEEV

    KAMAL

    RAMYAD

    CHOUDHARY 10785 FIT 17.12.2018

    22 1523540977 MUKESH

    KUMAR RAJAK BHIKHAN BAITHA 10505 FIT 17.12.2018

    23 1523952139 AMAN KUMAR

    JAMBOLKAR RAJU 10044 FIT 17.12.2018

    24 1523353598

    ROSHAN

    KUMAR

    SURYAVANSHI

    CHANDAN

    PRASAD

    SURYAVANSHI

    10748 FIT 17.12.2018

    25 1523292668 ROHANI RAJAK LATE KISTO

    RAJAK 10734 FIT 17.12.2018

    26 1523452127 PATIL ROSHAN

    RAMDASJI

    RAMDASJI

    LODKU PATIL 10570 FIT 18.12.2018

    27 1523894728 AANAND

    KUMAR SHIVPAL 10003 FIT 18.12.2018

    28 1523442893 VISHWANAT

    BHARTI SITARAM BHARTI 10982 FIT 18.12.2018

    29 1523334208 BIKASH KUMAR

    PASWAN

    INDRADEO

    PASWAN 10173 FIT 18.12.2018

    30 1523253629 KING KAUSHAL

    KUMAR

    UPENDRA

    PASWAN 10400 FIT 18.12.2018

    31 1523248476 SHAILPIK

    MONDAL

    SUBHAS

    CHANDRA

    MONDAL

    10818 FIT 18.12.2018

    32 1523356424 KEWAL PATIL GANESH PATIL 10397 FIT 18.12.2018

    33 1523334253 ARUN KUMAR

    NAG

    TARUN BALADEV

    NAG 10102 FIT 18.12.2018

  • 34 1523432214 BISHIKESH

    NAIK SANATAN NAIK 10188 FIT 18.12.2018

    35 1523336888 RAMAN

    PASWAN

    RAM LAKHAN

    RAM 10683 FIT 18.12.2018

    36 1523431864 VIKAS NAG DHRUV SINGH

    NAG 10967 FIT 18.12.2018

    37 1523430955

    RAKESH

    BHIMRAO

    JANGLE

    BHIMRAO

    SHRIPAT JANGLE 10669 FIT 18.12.2018

    38 1523938634

    AJINKYA

    ARVIND

    TEMBHURNE

    ARVIND

    TUKARAM

    TEMBHURNE

    10027 FIT 18.12.2018

    39 1523276681 ABHIMANYU

    KUMAR RAMU RAM 10005 FIT 18.12.2018

    40 1523258416 AVINASH

    KUMAR RAM BARAN RAM 10133 FIT 18.12.2018

    41 1523678295 UTTAM DAS MAKHAN RAVI

    DAS 10953 FIT 18.12.2018

    42 1523435811 LALOO PRASAD GHANA RAM 10431 FIT 18.12.2018

    43 1523360026 MILIND

    BHIMRAO TIPLE

    BHIMRAO

    MADHAO TIPLE 10484 FIT 18.12.2018

    44 1523543310 OMKAR

    TANDAN

    JAG RAM

    TANDAN 10552 FIT 18.12.2018

    45 1523687331 ABHIJIT MAJI SUBHAS MAJI 10004 FIT 18.12.2018

    46 1523346406 RASAPALLI

    RAMESHKUMAR

    RASAPALLI

    RAJAMOULI 10705 FIT 18.12.2018

    47 1523286082 KANAKAM

    SRINIVAS LINGAIAH 10378 FIT 18.12.2018

    48 1523418735 SHIVSHANKAR

    GOUR

    CHHABILAL

    GOUR 10843 FIT 18.12.2018

    49 1523345042 NAVEEN

    SHENGARAP

    MURLI

    SHENGARAP 10530 FIT 18.12.2018

    50 1523347052 SACHIN PATIL UMESH PATIL 10755 FIT 18.12.2018

  • 51 1523598964 ASHOK KR

    HARIJAN SANKAR HARIJAN 10114 FIT 19.12.2018

    52 1523943674 MANOJ KUMAR DULARCHANDRA

    RAVIDAS 10460 FIT 19.12.2018

    53 1524155698 SAPIDI

    JEEVANKUMAR SHANKAR 10801 FIT 19.12.2018

    54 1523263075 SANGRAM

    KESHARI MAJHI SUDARSAN MAJHI 10776 FIT 19.12.2018

    55 1523883995 BRAHMA RAM SUREN RAM 10191 FIT 19.12.2018

    56 1523452098 LALJEET

    KUMAR

    KULDEEP

    BHUIYAN 10430 FIT 19.12.2018

    57 1523262265

    NARNAWARE

    PRADIP

    CHINTAMAN

    CHINTAMAN

    NARNAWARE 10528 FIT 19.12.2018

    58 1523792705 KUNDAN B

    URKUDE

    BABARAO

    KASHINATH

    URKUDE

    10418 FIT 19.12.2018

    59 1523874355 PREMKUMAR

    SIRSILLA JAIRAJ SIRSILLA 10608 FIT 19.12.2018

    60 1523283461 MANOJ KUMAR

    RAM

    BIRENDRA

    KUMAR 10466 FIT 19.12.2018

    61 1523261582 SUVANKAR

    BAIN KALYAN BAIN 10928 FIT 19.12.2018

    62 1523274394 SAURABH

    KUMAR PYARE LAL 10814 FIT 19.12.2018

    63 1523348078 RABI PASWAN GANDHI PASWAN 10617 FIT 19.12.2018

    64 1523350841

    VISHNU

    VARDHAN

    MARAPELLI

    KOMURAIYA

    MARAPELLI 10981 FIT 19.12.2018

    65 1523621969 SUSHIL KUMAR

    BAGHEL FUL SAI BAGHEL 10925 FIT 19.12.2018

    66 1523715388 AMIT R

    NIRAMAL

    RAJARAM

    NIRMAL 10061 FIT 19.12.2018

    67 1524039553 MUNENDRA

    MAJHI SRIKANTA MAJHI 10510 FIT 19.12.2018

  • 68 1523452519 BRUSABHANU

    BEHERA

    SUDARSAN

    BEHERA 10196 FIT 19.12.2018

    69 1523243580 RAJDEEP DAS NARAYAN

    CHANDRA DAS 10632 FIT 19.12.2018

    70 1523461547

    AKSHAY

    MANISH

    JAMBHULKAR

    MANISH

    JAMBHULKAR 10041 FIT 19.12.2018

    71 1523269580 MANI KANT

    RAVI

    RAJ KISHOR

    PRASAD 10449 FIT 19.12.2018

    72 1523691924 RAJESH MAL SIMAI MAL 10648 FIT 19.12.2018

    73 1523519325 ANIL KUMAR

    BEHERA BIPIN BEHERA 10078 FIT 19.12.2018

    74 1523519289

    AKSHAYKUMAR

    RAJENDRA

    DONGARE

    RAJENDRA

    DONGARE 10042 FIT 19.12.2018

    75 1523601469 KALI DAS MONOHAR DAS 10374 FIT 19.12.2018

    76 1523613238 KANHAIYA

    NAGWANSHI RAMTA PRASAD 10380 FIT 20.12.2018

    77 1523951708 FIRDOS

    BUNKAR GANPAT RAO 10289 FIT 20.12.2018

    78 1523280997

    SIDHANT

    LOMESH

    KHARTAD

    LOMESH 10854 FIT 20.12.2018

    79 1523343393 DEEPAK

    KUMAR MURMU

    DAKSHINESHWAR

    MANJHI 10236 FIT 20.12.2018

    80 1523805233 CHARAN DAS

    MANIKPURI

    KODU LAL

    MANIKPURI 10210 FIT 20.12.2018

    81 1523419536 DINABANDHU

    BAGH GANJU BAGH 10269 FIT 20.12.2018

    82 1523535341 KANDRA

    MURMU JAIRAM MURMU 10379 FIT 20.12.2018

    83 1523430141 AKASH

    ERPACHI

    SHIVPAL SHAH

    ERPACHI 10030 FIT 20.12.2018

    84 1523950700 BIRAJLAL

    WARKDE

    MADRASING

    WARKADE 10183 FIT 20.12.2018

  • 85 1523785094 NIRBHAY

    KUMAR MINZ BHAWANI ORAON 10542 FIT 20.12.2018

    86 1523341078 SANTOSH

    KUMAR SHIVBACHAN 10790 FIT 20.12.2018

    87 1523519089 BASTA MARDI LUGU MARDI 10152 FIT 20.12.2018

    88 1523338265 DASHRATH

    HANSDA

    RAMCHARAN

    HANSDA 10226 FIT 20.12.2018

    89 1523373914 JITENDRA

    UIKEY MANGAL SHAH 10364 FIT 20.12.2018

    90 1523334610 ANAND KISHOR KISHORI PD

    VISHVKARMA 10066 FIT 20.12.2018

    91 1523509455 DABLU MODI CIVIL MODI 10222 FIT 20.12.2018

    92 1523712452 SANTU KORA LATE MANTU

    KORA 10799 FIT 20.12.2018

    93 1524067759 DILIP KUMAR

    IWNATI

    AMIRCHAND

    IWNATI 10264 FIT 20.12.2018

    94 1523344088 ASHOK KUMAR

    MANKI

    AMARNATH

    MUNDA 10118 FIT 20.12.2018

    -sd-

    General Manager /Rect.)ECL

  • BOND FOR CANDIDATE SELECTED FOR MINING SIRDAR UNDER EASTERN

    COALFIELDS LIMITED

    KNOW ALL MEN BY THESE PRESENTS THAT I (CANDIDATE NAME) , son of (Father’s Name) by Caste ______ resident of _______ Dist. ____, State – ______ & at present residing at ______ Dist. ___, State – ____ hereinafter called ‘the CANDIDATE’, do hereby bind myself to pay to the Eastern Coalfields Limited, having its registered office as ‘EASTERN COALFIELDS LIMITED, Sanctoria, P.O. - Dishergarh, Dist. – Burdwan, West Bengal – 713333’ (hereinafter called “the Company”), on demand the sum of Rs.1,00,000/- (Rupees One Lakhs only) or the amount received by the CANDIDATE as pay, allowances, traveling expense and cost of equipment etc., during the period of probation and service in the Company together with interest (as prevalent bank rate which ever is less, to be paid to the Company) their successors and assigns at Sanctoria, Burdwan (WB). Dated this ______ day of ____, Two Thousand and Eighteen. WHEREAS the above bounden CANDIDATE has been selected by the Company for employment. The condition of the above written obligation along with the terms of the letter of appointment is that: (a) Failing to continue the job for which he has been selected for reasons other than ill-health

    PROVIDED THAT such ill-health has not been brought on by his own neglect, carelessness or misconduct. PROVIDED FURTHER THAT the opinion of Medical Officer of the Company or any other Medical Officer nominated by the Company shall be final both in regard to the ill-health or whether the ill-health has been brought on by the negligence, carelessness or misconduct of the above bounden CANDIDATE.

    (b) Refusing to serve the Company for a minimum period of 36 months in any capacity commensurate with his job description as directed by the Company.

    (c) Failing to refund the Company an over-payment made to him during the course of probation as MINING SIRDAR, the service will be liable to termination and the above bounden CANDIDATE shall forthwith refund to the Company on demand and without demur an amount at the following rates:

    Total emolument drawn during the the total amount so repayable by Period of Probation (plus interest thereon the CANDIDATE shall in no event exceed Calculated at the prevalent rate). Rs.1,00,000/- (Rupees One Lakhs) only.

    AND UPON his making such refund the above written obligation shall be void and of no effect, otherwise it shall remain in full force and virtue. PROVIDED ALWAYS that it is hereby agreed and declared that the decision of the Company as to whether the above bounden CANDIDATE has or has not performed and observed the obligation and conditions herein shall be final and binding. PROVIDED FURTHER that this bond shall in all respects be governed by the laws of India. The Company may, however at its discretion alter/interrupt the probation and services of said Shri (CANDIDATE NAME). Signed and delivered by the above bounden in my presence Signature of Candidate SEAL and Signature of Notary Public Address (Present and Permanent)- At - __(Place)__ Dated the _____ day of _____,Two Thousand and Eighteen

  • EASTERN COALFIELDS LIMITED (A subsidiary of coal India Ltd.)

    Office of the CMD`s, Sanctoria

    P.O.-Disergarh, Dist.-Burdwan

    1. The furnishing of false information or expression of any factual information in the Attestation form

    would be a disqualification and is likely to render the candidate unfit for employment under the

    Government.

    2. If detained, convicted, debarred etc. Subsequent to the completion and submission of this form, the

    details should be communicated immediately to the Eastern Coalfields Ltd. Or the authority to whom

    the Attestation Form has been sent earlier, as the case may be, falling which it will be deemed to be a

    suppression of factual information.

    If the fact that false information has been furnished or that there has been suppression of any factual

    information in the Attestation Form comes to notice at any time during the service of a person, his

    service would be liable to be terminated.

    1. Name in(in block capitals) full with Surname

    Aliases, indicate if you have added

    dropped In any stage any part of

    your name surname.

    Name

    2.Present address in full i.e. Village,

    Thana and District or House number,

    Lane\Street Road and Town.

    3.(a) Home address in full i.e. Village

    Thana and District or House number,

    Lane/Street Road and Town.

    3. (b) If originally a resident of Pakistan\

    Bangladesh/Nepal, the address in

    That country and the date of migration

    In Indian union.

    4. Particulars of places (with periods of residence) have resided for more than year at a time

    during the last five years. In case of stay abroad (including Pakistan/ Bangladesh/Nepal, particulars of

    all places where you have resided for more than one year after attaining the age of 21 years should be

    given.

    From To Residential address

    In full i.e. Village,

    Thana and district or

    House no. Lane/ street

    no .and Town.

    Name of the District

    HQ. of the place

    mentioned in the

    proceeding Col.

    Contd..................2

  • (2)

    Name Age/Date Of Birth

    Nationality Place of

    Birth

    Occupation

    (if employed,

    give

    design.official

    Address)

    Marital

    status

    Present

    Address

    (if

    dead give

    last

    address)

    Permanent

    Home

    address

    1.Father

    2. Mother

    3.Wife/

    Husband

    4.Brother

    5.Sister

    6.Children

    7.Any other

    dependent

    (Mention

    relationship)

    5. (a) Information to be furnished with regard to sons and or daughters in case they are studying / living in a

    Foreign Country.

    Name

    Nationality by birth

    or by domicile.

    Place of Birth Country in which

    studying / living

    with full address.

    Date from which

    living in the

    Country mention in

    previous col.

    6. Nationality

    7. a) Date of birth (a)

    b) Present age (b)

    c) Age at Matriculation (c)

    8. a) Place of birth, District & State in which situated (a)

    b) District & State which you belong (b)

    c) District & State which to your father originally belong (c)

    9. a) Your religion.

    b) Are you member of Scheduled Caste, Scheduled Tribe /

    Physically handicapped/ ex – serviceman/ Backward Class Community?

    Contd............3

  • (3)

    C) Answer Yes or no and if the answer is yes, state the name thereof.

    10. Education qualification showing places of education with years in School & College since 10th

    year of age.

    Name of School/College

    with full address

    Date of entering Date of leaving Examination passed

    11. Are you holding or have at any time held an appointment under the Central or State Government or a

    Semi – Government or Quasi Government body or any autonomous body on public undertaking or a

    Private firm or Institution? If so, give full particulars with dates of employment upto date.

    Period Designation, employment

    and nature of employer

    Full Name and Address

    of employer

    Reason for leaving

    previous service.

    (b) If the previous employment was under the Government of India / State Govt./ an undertaking owned or

    controlled by the Government Of India or a State Government / an autonomous body / University / Local

    body. If you had left the service on going a month’s notice under Rules of the Central Civil Service

    Temporary Service Rules,1965 or any similar corresponding rules were disciplinary preceedings framed

    against you or had you been called upon to explain your conduct in any matter at the time you given notice

    or termination of service or at a subsequent date, before your service actually terminated.

    12. a) Have you ever been arrested ? Yes /No

    b) Have you ever been prosecuted? Yes /No

    c) Have you ever been kept under detention? Yes /No

    d) Have you ever been fined by a Court of Law? Yes /No

    e) ) Have you ever been convicted by a Court of Law for any or offence? Yes /No

    f) Have you ever been debarred from any examination or restricted by

    any University or any education authority Institution ? Yes /No

    g) Have you ever been debarred, disqualified by any Public Service

    Commission from appearing in its examination selection? Yes /No

    h) Is any case pending against you in any court of law at the time of filling

    up this Attestation Form? Yes /No

    i) If any case pending against you in any University or any other education

    authority institution at the time of filling up this Attestation Form? Yes /No

    j) If the answer to any of the above mentioned question is ‘YES’ give full particulars of the case- arrest/

    detention/ file conviction/ sentence/ punishment etc. and or the nature of the case and in the

    Court/University/Education Authority etc . at the time of filling up this form.

    Note:

    i) Please also see the warning at the top of this Attestation Form.

    ii) Specific answer to each of the question should be given by striking out ‘YES’ / No as the case may be.

    13. Name of two responsible persons of your locality or two references with full address (not relations) to

    whom you are known.

    Contd.........4

  • (4)

    I certify that the foregoing information is correct and complete to the best of knowledge and belief. I am aware

    of any circumstances which might impair my fitness for employment under Government.

    Signature of Candidate.

    Designation

    Date

    Section/ Department

    Place of Posting

    Date of Joining

    IDENTITY CERTIFICATES

    (Certificate & photograph of the candidate to be signed by one of the following)

    1. Gazetted Officer of Central or State Govt. 2. Member of Parliament or State Legislature belonging to the

    Constituency where the candidate or his parent/ guardian is

    originally resident.

    3. Sub- Division Magistrate /Officer. 4. Tahasildars or Naib/ Dt. Tahasildars authorised to exercise

    Magistrate powers.

    5. Principal / Head Master of the recognised School / College/ Institution where the candidate studied last.

    6. Block Development Officer & Mukhiya of Gram Panchayat.

    Certified that i know Shri / Smt / Kumari ___________________________________________

    Son / Daughter of shri ____________________________________whose photography has been attested by me

    above for the last ________________Years ______________Months and that to the best of my knowledge and

    belief the particular furnished by him or her are correct.

    Place: Signature:

    Date:

    Designation or Status and address with Seal

    TO BE FILLED BY THE OFFICER

    1. Name, Designation, full address of the appointing authority.

    2. Post for which the candidate is being considered.

  • DECLARATION

    I Sri /Smt. / Kumari______________________________________________________________

    S/o D/o_______________________________________________of__________________village

    /town_______________________________________ Po:_______________________________

    Thana_______________________Dist.________________________State__________________

    _________Pin______________________do hereby declare that I am unmarried/ married

    having only one wife / husband.

    Date: Signature of the candidate

    ________________________________________________________________________

    DECLARATION

    I Sri /Smt. / Kumari______________________________________________________________

    S/o D/o_______________________________________________of__________________village

    /town_______________________________________ Po:_______________________________

    Thana_______________________Dist.________________________State__________________

    _________Pin______________________do hereby declare that I am unmarried/ married

    having only one wife / husband.

    Date: Signature of the candidate