APPLICATION FORM To, Principal Sainik School Rewa (MP) 486001 1. Name of Post Applied : ____________________________ 2. Name of Applicant : ............................................................................................ (In Capital BLOCK letters) 3. Father's/Husband's Name : ............................................................................................. 4. Caste (Certitificate as per adver- : SC / ST / OBC / GEN tisement be enclosed) 5. Religion : ............................................................................................. 6. Gender : Male / Female / Others 7. Date of Birth (DD/MM/YYYY) : .........../.........../...................................... (in Words) : .............................................................................................. 8. Marital Status : .............................................................................................. 9. Correspondence Address : .............................................................................................. .............................................................................................. .............................................................................................. ..........................................................................PIN............... Mobile ................................................................................... E-mail .................................................................................... 10. Permanent Address : .............................................................................................. .............................................................................................. .............................................................................................. ...........................................................................PIN.............. Mobile ..................................................................................... 11. Educational Qualification Class 10th onwards (enclose copy of certificates) : S. No. Name of Exam Subject Board / University Passing Year Percentage Self attested recent passport photograph of applicant Application No : ____ _______ For Office Use Only 12. Technical Qualification (enclose copy of certificates) : S.No. Name of Exam Name of Board / University Passing Year Percentage 13. Knowledge of Computers : .............................................................................................. ............................................................................................... 14. Work Experience : ............................................................................................... ............................................................................................... ............................................................................................... ............................................................................................... 15. Details of Application Fee : Demand Draft No ............................. dated ................................ Issued by Bank ........................................................................ 16. Is any case pending against you in any court of law / police station? If any, furnish details ......................... ............................................................................................... Date ........................ Signature of Applicant Name .................................. DECLARATION I hereby affirm and declare that the statements made in the application are true and unexaggerated. I undertake that any misrepresentation or material omission made in this application from will render the undersigned liable to immediate rejection of candidature / employment at any stage. Date ........................ Signature of Applicant Name .................................. Enclosures :- 1. ....................................................... 7. ....................................................... 2. ....................................................... 8. ....................................................... 3. ....................................................... 9. ....................................................... 4. ....................................................... 10. ....................................................... 5. ....................................................... 11. ....................................................... 6. ....................................................... 12. ....................................................... FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES APPLYING FOR POSTS This is to certify that Shri/Smt./Kumari __________________________________ son/daughter of _____________________________________________ of village/town _______________________________ in District/Division ____________________ in the State/Union Territory ________________ belongs to the ______________________ community which is recognized as a backward class under the Government of India, Ministry of Social Justice and Empowerment’s Resolution No. _____________________ _______________________________________________ dated ________________*. Shri/Smt./Kumari _____________________________________ and /or his/her family ordinarily reside(s) in the __________________ District/Division of the ______________ State/Union Territory. This is also to certify that he/she does not belong to the persons/sections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India, Department of Personnel & Training O.M. No. 36012/22/93-Estt. (SCT) dated 8.9.1993, OM No. 36033/3/2004- Estt. (Res) dated 9th March, 2004, O.M. No. 36033/3/2004-Estt. (Res) dated 14th October, 2008 and O.M. No. 36033/1/2013-Estt. (Res) dated 27th May, 2013**. Signature________________ Designation_______________$ Dated: Seal *- The authority issuing the certificate may have to mention the details of Resolution of Government of India, in which the caste of the candidate is mentioned as OBC. **- As amended from time to time. $ - List of Authorities empowered to issue Other Backward Classes certificate will be the same as those empowered to issue Scheduled Caste/Scheduled Tribe certificates. Note:- The term “Ordinarily” used here will have the same meaning as in Section 20 of the Representation of the People Act, 1950. FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE) I __________________________________ Son/Daughter of Shri ____________ __________________________ resident of village / town / city ____________________ district ________________ state ______________ hereby declare that I belong to the _________________________ community which is recognized as a backward class by the Government of India for the purpose of reservation in services as per orders contained in Department of Personnel and Training Office Memorandum No 36102/22/93-Estt.(SCT) dated 08-09-1993. It is also declared that I do not belong to persons / sections / sections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred Office Memorandum dated 08-09-1993, O.M. No. 36033/3/2004-Estt.(Res.) dated 9th March, 2004 and O.M. No. 36033/3/2004-Estt.(Res.) dated 14th October, 2008. Signature __________________________ Full Name __________________________ Address ___________________________ __________________________________