Application Cum CONCENT FORM For Charge of DPMU/BPMU Statff

Name: Father's /Husband Name:
Mobile No: Email ID:
Present Place Of Posting
Division: District:
Block: Designation (Current Post):
Present Address:
Date Of Birth:   (dd/MM/yyyy) Sex:
Education Qualification(regular course):
S.No. Qualification Details Institute/University Passing Year Total Marks Marks Obtain
1 High School
2 Higher Secondary
3 Graduation
4 PG
5 Others
Posting History:
S.No. Name of the Post From(Start Date) dd/mm/yyyy To(End Date) dd/mm/yyyy Reason For Change(Transfer/Promotion etc)
1
2
3
Management related Training/Courses attented in last 5 years:
S.No. Name of the Program From(Start Date) dd/mm/yyyy To(End Date) dd/mm/yyyy
1
2
3
SCN's/Disciplinary Action/Court Cases (if any)-provided details:
S.No. Type of issue Status
1 SCN
2 Suspension
3 Court case
4 Any Other disciplinary issue
Computer Knowledge:
Computer related courses qualified:
Preferred district for posting:
1. 2.
3. 4.
Please the above formate in original along with certifiicates must be carried to state, when called for Test/interview with Signature:
VERIFICATION
This is certify that the details, Submitted above by Mr./Ms ........................................................................
S/o ,W/O .............................................................................Posted as........................................................
At ........................................................................................is rue as per offical records availabel.
 
Seal & Signature of CM&HO /BMO
Date:                                  
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