Annexure Application Form For Central Public Sector Executives/govt. Officers Page 2
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1
2-2-
7(a). Details of experience relevant for the advertised post and job description, out of 7 above:
Sl.
Designation,
Organization
From
To
Pay scale
Nature of
No.
and place of posting
experience
1.
2.
3
4
Note :
1. You may attach a write up, if you wish, not exceeding two pages, in support of your candidature.
2. Full form of all abbreviations used while making entries in the application form should be suitably
explained i.e in footnotes or a separate attachment.
Do you hold lien in any other organization
8 (A)
other than where currently working ?
Yes
No
If yes:
a) name of the organization in which the lien is held :-
b) date from which the lien is held :-
(B) Are you on deputation?
Yes
No
If yes:
Date from which you have been on deputation :-
Yes No
Whether any punishment awarded to the applicant during the last 10 years.
9 (a)
If yes, the details thereof
Whether any action or inquiry is going on against him as far as his knowledge goes
.
(b)
Yes No
If yes, the details thereof
CERTIFICATE
I certify that the details furnished by me in Cols. 1 to 9 are true to the best of my
knowledge and belief.
UNDERTAKING
I hereby undertake to join the post, if selected. I understand that if I convey my
unwillingness to join after the interview is held, but before the appointment is processed,
or after issue of offer of appointment, I may be debarred for a period of two years for being
considered for a Board level post in any CPSE other than the one to which I belong.
(Name and Signature of the applicant)
Date:
To be filled by the PSU/Ministry /Department concerned
(
)
It is certified that the particulars furnished above have been scrutinized and found to be correct as
per official records.
Signature & Designation of
the Competent Forwarding
Authority with Telephone no. & Office Sea
l.
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