Vijay Ohpcl
Vijay Ohpcl
Application Form for Operator-C (El)/ Electrician-C / Crane Operator-C /Welder-C/ Fitter-C
Advertisement No. OHPC: HQ: HRD: RECTT: 07/2012 [Application to be submitted in A4 size paper only] FILL IN CAPITAL LETTERS AND SIGN AT THE BOTTOM OF EACH PAGE
1. Post applied for (please tick any one): a) Operator-C (El) b) Electrician-C C) Crane Operator-C D) Welder-C E) Fitter-C 2. Name (in Capital Block Letters) : First Name: Middle Name: Last Name: 3. (A) Address for Correspondence: (Do not mention your name) : : : : : Paste one recent passport size colour photograph signed on the front. Do not staple or pin.
STATE: Contact Telephone No. E-mail : (Active for the next 12 months)
(B) Nearest Railway Station/Bus Stand from mailing address mentioned above: State: 4. Date of Birth: (as recorded in Matriculation or equivalent certificate) Date 5. Age as on 1.8.2012: 6. Sex () : Male Years Female (Full signature of candidate) 1 Month Month(s) Year Day(s)
7. Fathers/Husbands Name: 8. Category: (Please put a mark in the appropriate box) General SC ST SEBC
(Candidates belong to SC/ST/SEBC/PWD categories must attach the attested copies of relevant certificate issued by the Competent Authority) 9. Additional information: (Use mark in the appropriate box) PWD 10. Nationality: 11. Age Relaxation claimed: YES NO (Use mark) Ex- Serviceman
12. Preferred choice of Centre for Written Test: (Please put a mark in the appropriate box) Bhubaneswar Sambalpur / Rourkela Koraput Other city
Examination Passed
Discipline/Subject
Course Duration
In case of CGPA/Grades please give equivalent percentage (attach photocopies of the certificate and Mark sheet towards proof of essential qualification) 14. EDU C A T I ON A L QUALIFICATIONS (As per the detailed Advertisement and from Matriculation onwards) (Please attach additional sheet(s) as per the format below if required) Sl. No. Examination Passed Name of the Institute/University Course Duration
Year & Month of Passing Percentage of marks up-to two decimal points in aggregate/ CGPA
Discipline/Subject
In case of CGPA/Grades please give equivalent percentage (attach photocopies of the certificate and marksheet towards proof of educational qualification) (Full signature of candidate) 2
15. POST QUALIFICATION RELEVANT EXPERIENCE (If any): (Please attach additional sheet(s) as per the format below if required) Duration (DD/MM/YYYY) From Date To Date Gross Annual Emoluments (in Lacs)
Sl. No.
Pay Scale
16. Particulars of Demand Draft: (SC, ST, PWD candidates are exempted from the payment of fees)
Name and Address of Issuing Bank Date of Issue Amount (Rs.) Demand Draft No.
DECLARATION: I hereby declare that I have car efully read the conditi ons of eligibility mentioned in the advertis ement. These conditions ar e acceptabl e to me & I fulfil thes e conditions. The details menti oned in the application are true & I shall furnish the neces sary certificates in pr oof of the above along with the application. If any inform ation/ details found t o be i ncorrect/ fals e at any stage of the sel ection or if any fact found to have been c oncealed by me are detected ev en after the appointm ent, my services may be termi nated. Place: Date: _________________________ (Full Signature of the Candidate)