Application For The Post Of Chief Executive Officer Page 4
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4PENSION FUND REGULATORY AND DEVELOPMENT AUTHORITY
APPLICATION FOR THE POST OF CHIEF EXECUTIVE OFFICER, NEW PENSION SYSTEM TRUST
(ON CONTRACT/DEPUTATION BASIS)
1.
Name in full
First Name
(English-
Middle Name
CAPITAL LETTERS)
Surname
2.
Father’s Name
Sex (Please √
3.
M
F
wherever
Paste Photograph in
)
applicable
the box alongside and
4.
Date of Birth
D
D
M
M
Y
Y
Y
Y
sign across it
5.
Age as on
01.04.2015
Years
Mths
6.
Category, i.e. General/
General
OBC
SC
ST
PWD
SC/ST/ OBC/PH (Please √
)
wherever applicable
On Deputation
Mode of appointment (Please √ wherever applicable
)
7.
On Contract
8.
Details of Work Experience as on 01.04.2015
Employer Name & address
Designation
Job Profile
Period
Duration
From
To
Yrs.
Mths
9.
Academic Qualification as on 01.04.2015
Qualification
Examination
Main
Year of
University/
Overall
Class/
Subjects
Passing
Institute
(%) of
Division
Marks
Graduation
Post Graduation
Any Other
10. Postal Address (English – in capital letters only)
E Mail:
Telephone:
Mobile:
Dist.:
STD Code:
State:
Pin Code:
Any other information considered relevant by the applicant :
I declare that the information furnished above is true and correct to the best of my knowledge & belief. I understand
that if at any stage, it is found that any information given in this application is false/incorrect or that I do not satisfy the
eligibility criteria according to the Authority, my candidature/appointment is liable to be cancelled/terminated. I have
read and understood the stipulations given in the vacancy circular and hereby undertake to abide by them.
Place:
Date:
Signature
Note: Applications should be accompanied by self attested copies of certificates in support of age, qualifications &
experience, Caste/Tribe/Community/Physical disability as applicable, with a recent passport size photograph glued to
the top right hand corner of the application form.
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