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Application For Endorsement Of Cable Jointing Examination 2022
All (
*
) fields are compulsory
*
Workman Category
:
--Select--
Wireman-MV
Lineman-MV
Workman-HT
*
Issuing Authority
:
--Select Authority --
Code
Number
*
Workman Permit No
:
-
*
Valid Upto
:
*
Name of the Applicant (In Block Letter)
:
*
Name of the Father
:
*
Present Address
:
Characters left.
*
Permanent Address
:
Characters left.
*
Date Of Birth
(Minimum age limit is 20 yrs)
:
Age as on date of apply
:
*
Gender
:
Male
Female
*
Category
:
General
SC/ST
*
Mobile No
:
*
Email Id
:
PRESENT EMPLOYEMENT DETAILS
Wheather Employed(Present Status Of Employment)
:
Yes
No
If Yes, Then
: Working as (Designation)
:
Name of the Office/Firm
:
Date of Employement
:
TREASURY CHALLAN DETAILS
*
Challan No
:
*
Amount
:
*
Date
:
*
Name of the Treasury
:
CHOICE OF CENTER
*
EI Office
:
*
First Choice
:
*
Second Choice
:
Third Choice
:
UPLOADED DETAILS
*
Photo & Signature
:
Yes
No
*
Personal detail page of Workman Permit Book
:
Yes
No
*
Validity date page of Workman Permit Book
:
Yes
No
*
Treasury Challan
:
Yes
No
*
Caste Certificate
:
Yes
No
UPLOAD DOCUMENTS
*
Upload Photo
(Only colored Passport size Photograph)
:
(Size between 10-20 KB) Only .JPG or .JPEG
*
Upload Full Signature
:
(Size between 10-20 KB) Only .JPG or .JPEG
*
Upload Personal Details Page of the Workman Permit Book
:
(Size between 50-100 KB) Only .PDF
*
Upload Validity date page of the Workman Permit Book
:
(Size between 50-100 KB) Only .PDF
*
Upload Treasury Challan
:
(Size between 50-100 KB) Only .PDF
Upload Caste Certificate
(In Case of SC/ST Candidates )
:
(Size between 50-100 KB) Only .PDF
DECLARATION
I hereby declare that the particulars stated above are correct and true to the best of knowledge and belief. If the information being found false or incorrect my application is to be cancelled at any stage.
*
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