7/31/2019 RRB Application Form

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RAILWAY RECRUITMENT BOARD Roll No. (For official use only)

PLEASE FILL UP THE APPLICATION INCAPITAL LETTERS IN OWN HANDWRITING.

6. DATE OF BIRTH(DD/MM/YYYY)

APPLICATION FORM FOR Employment Notice No ...../2011

UR OBC SC ST

Control No: (for office use)

Signature of candidate in thebox below the photog raph

Paste (do not pin or staple)here your colour passport sizephotographof size 4cm x 5cm

(The colour photographshould not be more than

3 months old)Not to be attested

8.Qualification (Fill in only those qualifications prescribed for the post/s applied for)

Signature of the Candidate

Qualification

Qualification

University/Board

University/Board

Year ofpassing

Year ofpassing

Subjects

Discipline / Trade

Marks %

Marks %

Annexure-1

Note: 1) C andidates must fill up their name, fathers name &dat e of birth as indicated in their matriculation certificate.2) Candidates should put their full signature at all the places in the same language (in English or in Hindi).

PIN CODE

(FOR CORRESPONDENCE)

9. ADDRESS

3. NAME OF CANDIDATE

st

1nd

2rd

3

Signature should not be in Capital letters.(All applications must be submitted in A4 size 80 GSM bond paper)

Cat. No Name of Post

5. FATHERS NAME:

Left Hand ThumbImpression of Candidatein this box

1. CATEGORY No. & POST(for single category)

2. Choice of Railway :(Wherever applicable)

4. COMMUNITY(Tick )

(A) Academic

SSC/X/Matric

HigherSecondary/Inter

Graduation

Post Graduation

Others

I.T.I/ApprenticeDiploma

Engineering Degree

(B) Technical

Others

years months days

7. AGE AS ON 01-07-2012

10. ARE YOU

11. Present employment (To be filled by all Railway/Central/State/PSU employees)

12. Ex-servicman (Ex-SM)

Date of Enrolment Date of Attestation Date of Discharge

Designation & Grade Date from Date to Name & address of Employer

(i) Govt. Employee (ii) Ex-serviceman Yes/NoYes/No

Length of Service

(iii) Physically Challenged Yes/No

VH HH OH

7/31/2019 RRB Application Form

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NEAREST RAILWAY STATION(For issue of free Railway pass to SC / ST candidates)

5.

VISIBLE MARK OFIDENTIFICATION ON BODY

6.

To be filled compulsory

7. Medium of Examination (Choose any one of the regionalLanguages of concerned RRB as mentioned in Sr. No. 15)

RAILWAY RECRUITMENT BOARD, INFORMATION SHEET (For Centralised Employment Notice No..../2011)(To be filled in CAPITAL LETTERS only - Signautre should not be in Capital / Open letters)

1. NAME OF CANDIDATE

2. Tick( )Gender

4. Permanent address :

Female Male 3. Nationality

State PIN Code

10. Do you seek age relaxation

11. Whether you were debarred by any RRB in the past a) No b) For 2 years c) For life

13. Please copy the followingdeclaration in your own hand writing in running hand in the spaceprovided below:

Place:Date:

I hereby declare that all the statements made by me in the application are true and complete to the best of

my knowledge and belief and nothing hasbeen concealed or suppressed. I also understand that in case, any of my

statements is found untrue during any stage of recruitment or thereafter shall disqualify me for the post

applied for and I shall also be liable forany other action under the extant rules

12.

( ) TICK appropriate boxSC ST OBC Judicially separated/

divorced woman / widowJ & K

Resident Ex - SM

IPO/DD

PWD

Document attached in proof of: Indicate by ( ) Tick mark in the relevant boxes indicated below

CommunityCertificate(for SC/STOBC)

(ForEx-Serviceman)

Discharge Certificate

QualificationCertificate

Matric/SSLC Certificate(for DOB Proof)

Declaration from Visually handicappedCandidates as per Annexure: 10

Left Hand Thumb Impression of Candidate

in this box

MarriedMaritalStatus

Unmarried

Annexure-2

NAME OF POST OFFICE / BANK SERIAL NO. AND DATE

8 (a) Details of Postal Orders / Demand Drafts (DD) enclosed

AMOUNT

RailwayEmployee

9. RELIGION: HINDU MUSLIM CHRISTIAN SIKH BUDDHIST JAIN PARSI OTHERS

Course CompletedAct Apprentice

8 (b) Do you seek feesexemption

Signature of the candidate

Self Declarationfrom OBC candidatesas per Annexure-5

Self Declaration of MinorityCommunity (As per Annexure-8)

( ) TICK appropriate box

SC ST Female Candidate Ex - SMPWD Minority communityEconomically Backward

Classes (Ref. Annexure: 8)

Disability ertificate(for PWD as per Annexure:9)

C

Income Certificate for EconomicallyBackward class Certificate (As per Annexure-7)