Dev Form1 - Developer Manatosh

Application For One Stop Centre

To
The Additional District Magistrate
Alipurduar

Application for the post of:

1.Name of the Applicant(In Block Letters):[Name as recorded in the Matriculation / Secondary Examination Certificate]

2.Father’s / Mother’s / Husband’s name:

3.Gender:Female

4.Date of Birth(yyyy/mm/dd): [Date of Birth as recorded in the Birth Certificate issued by the competent
Authority /madhayamik/Secondary Examination/ School Leaving Certificate]

5.Age: [Age as on 1st January 2022]

7.Religion : Nationality :

8.Mobile No. : Email Id :

9.Permanent Address :

Vill./ Street : P.O. : Block / Muni. : P.S. :
District : Pin :

10.Present Address :

Vill./ Street : P.O. : Block / Muni. : P.S. :
District : Pin :

11.Educational Qualification : [Mention from Matriculation and upwards as per attachment]

Sl.	Name of Exam./ Post Graduate/Graduate/HS/ Other Exams	Year of Passing	Universirt/Board/Institute	Full Marks	Marks Obtained	% of Marks Obtained
1
2
3
4
5
6

12.Details of knowledge in Computer and Proficiency in MS Office Package :

13.Details of experiences : (As per attachment)

Sl	Name of Organization	Govt./Private./NGOs	Period : From Date	Period : To Date
1
2
3
4

I do hereby declare that all the statement made by me in the application are true and complete to the best of my knowledge and belief. I also understand that in case any of my statement is found false or incorrect at any stage, my candidature should be cancelled and I shall be liable for any other legal action against me.

Date:

Place:

Yours faithfully,

Signature of the Applicant

NB: After submitting application Form online, download and print the application From and submit at Social Welfare Section, Doors Kanya, Alipurduar along with requisite documents as mentioned in Notification.