RAILWAY RECRUITMENT CELL, EAST COAST RAILWAYAPPLICATION FORM ( in A4 size paper )

  E.N. No.ECoR/RRC/D/2012 dated 31.07.2012

Read the Employment Notification carefully before filling up the application form:

1. Name of the candidate (in capital letters):

2. Father’s/ Husband’s name (in capitalletters):

3. Nearest Railway Station:

4. Full address for correspondence:

5. Sex:

6. Nationality:

7. Religion:

8. Marital Status:

9. Date of Birth: Date Month Year   10. Tick (√ )Community :

UR OBC SC ST

 

11. Educational Qualification tick ( √ ) the appropriate column:

SSC/Matric HSC/SSC ITI Diploma Non Technical Technical

 Graduate Post Graduate Graduate Post Graduate

13 Tick ( √ ) appropriate column, if applicable. (Enclose copy of certificate in support of claim)

Persons with DisabilitiesWidow / Divorced /Judicially separated

EconomicallyWeaker Section

ServingRailway

Employees

Central /State Govt.Employees

Staff of QuasiAdministrative

offices of Railways

Residents of Jammu &Kashmir VH HH OH

14. Write two visible Marks of Identification (Moles etc.):

1.

2.

 16. Put two specimen signatures below (Do not sign in capital letters): 17. Put two Left Thumb Impressions below(Must be clear and not smudged):

1. Specimen Signature 2. Specimen Signature 1. Left Thumb Impression 2. Left Thumb Impression

18. DECLARATION BY THE CANDIDATE (Please reproduce the paragraph in your own running handwriting in the space given below):

I hereby declare that all the particulars given above by me are true and correct to the best of my knowledge and belief. In the event of any information being found false, my candidature / appointment is liable to be cancelled / terminated.

 _________________________________________________________________________________________________________________________________ 

 _________________________________________________________________________________________________________________________________ 

 ________________________________________________________________________________________________________________________ 

19. Place : _____________________________________________ 20. Date: 21. Signature of the candidate (Do not sign in capital letters)

State PIN

Contact Phone No. with STD Code:

 

For office use only

 

12. Choice of language for Written Examination (English/Hindi/Urdu/Oriya/Telugu):

Paste your latest passport size photograph(4cm x 5cm)

15. Details of IPO/DD No.____________________ Date: ________________ Amount: _________ Name of the Post office / Bank _______________________