8/2/2019 Application Form+Executives

1/2

Dedicated Freight Corridor Corporation of India Limited(A Government of India Enterprises)(APPLICATION FORMAT)

Important Notes: (i) Before filling this form, read the instructions carefully. (ii) All entries should be made in capital letters. (iii) Th

Application to be made strictly in the following format and to be filled in ENGLISH Language only with BLACK BALL POINT PEN ONLY.

POST APPLIED FOR(Please indicate whether

Executive (Civil)/Executive (Electrical)/Executive (Signal & Telecommunication)

CATEGORY(Please indicate whether

UR/ OBC / SC/ STin the box)

SUB CATEGORY(Please indicate whetherPH/Ex-servicemen in the

box)

CHOICE OF EXAMINATION CITY(please indicate in the box)

1st Preference 2nd Preference

1. Candidates Name (in capital letters) (please keep one box blank between name, middle name & surname)

2. Father's/Husband's Name (in capital letters) (please keep one box blank between name, middle name & surname)

3. Date of Birth : 4. Age as on01.01.2012

DAY MONTH YEAR YEAR MONTH DAYS

5. Educational Qualification

Indicate Percentage of Marks for Qualification completed Do you fulfill theeligibility criteriaas per theAdvertisement

[Write: Yes/No]

J & KDomicile[Write:Yes/No]

Gender[Male/Female](Please Write)Diploma in

Civil/Electrical/ E&CPercentage of

MarksPost Qualification

Experience in years

6. Nationality & Religion 7. Are You DFCC Employee (Please tick )

Nationality YES

Religion NO

8. Application Fee: (Demand Draft in favour of DFCCIL, payable at New Delhi)

DD.No. Date Name of Bank Branch Address Branch Code Amount (Rs.)

(Candidates should write Name, Post applied for, mailing address and mobile no., in capital letters, on the reverse side of the Demand Draft)

9. Present Address of Candidate Address (in capital letters) With Black Ball Point Pen only

Signature of Candidate

Name :

Fathers Name : Address :

:

District :

State : Pin Code:

Please affix one recent

passport sizePhotograph without

attestation

Mobile No: Tel. NO. with STD Code:

8/2/2019 Application Form+Executives

2/2

10. Educational Qualification (Academic & Professional):

Examinationpassed

(starting frommatriculation)

Name of the Institute /University

MaximumMarks

Year ofPassing

MarksObtained

%age of marks(upto 2 decimals)

11. Post Qualification Experience, if any, starting from previous to present (Total Experience _____ Years _____Months

Post Held withscale of pay

Designation Name and Address ofEmployer

Period of Service TotalExperience in

years

Clearly indicate thenature of experience.

Also mention the nameof the project/unit

where worked

From To

12. Details of Computer Proficiency (if any)

13. Permanent Address:

DECLARATION

DECLARATION TO BE SIGNED BY THE CANDIDATE

I hereby certify and declare that (i) I am an Indian National, (ii) I have read the provisions given in the Advertisement, (iii) All statements made an

information given by me in this application are true, complete and correct to the best of my knowledge and belief. In the event of any informatioor part of it being found false or incorrect before or after the exam./interview or appointment, action can be taken against me by the DFCC and mcandidature / appointment shall automatically stand cancelled/terminated, (iv) I further declare that I fulfill all the conditions of eligibility regardiage, educational, technical qualifications, etc. prescribed for the post applied for as on ___________________. (v) In case my application is nreceived by DFCC within the stipulated date due to postal delay or otherwise, DFCC will not be responsible for such delay.

14. List of Enclosures:-

Place:

Date:(Signature of the Applican

Please affix one selfattested recentpassport sizephotograph

Name :Fathers Name :

Address :

:

District :

State : Pin Code: