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APPLICATION FORM
Afix a copy of signed photograph here and attach a copy of the same photograph with the application.

To, THE DIRECTOR( PERSONNEL) ASSAM STATE ELECTRICITY BOARD Bijulee Bhawan, 4D2, Paltanbazar, Guwahati-781001 POST APPLIED FOR : NAME: Sri/Smti
First Name Middle Name

Last Name

FATHER'S NAME: DATE OF BIRTH:
Day Month Year Secondary/Higher Secondary Education) (Date of birth must be supported by an attested copy of certificate or admit card issued by Board/Council of

ADDRESS FOR CORRESPONDENCE: C/O,Street etc. Area, Village etc. City/Town District PIN PERMANENT ADDRESS: C/O,Street etc. Area, Village etc. City/Town District PIN NATIONALITY: INDICATE IF S/C,S/T(P),S/T(H),OBC/MOBC: Whether Physically Handicapped: Telephone No. Telephone No.

(Please write SC for S/C, STP for S/T(P), STH for S/T(H) and OBC/MOBC for OBC/MOBC) (Attested copy of Caste Certificate issued by the competent authority must be enclosed with the application)

EDUCATIONAL QUALIFICATION : Name of the Examination Passed HSLC or Equivalent HSSLC or Equivalent Degree / Diploma in ________________ Any other Qualification(Please Specify) __________________
(Attested copies of all relevant marksheets must be eclosed with the application)

Name of the Board/Institute/University

Year of Passing

Division & Percentage of Marks obtained

EXPERIENCE:

No.of years Organisation:

Nature of Job :

PARTICULARS OF BANK DRAFT/IPO:

No. Amount:

Date:

PREFERENCE OF POSTING( IST/2ND OR 3RD)

GENERATION

TRANSMISSION

DISTRIBUTION

It is certified that the above particulars are true to my knowledge and belief. Further, I understand that if any of the above particulars is found false, my canditure will be automatically rejected.

Date:

(Enclosures)

Signature of the Candidate

(Please note that incomplete applications & applications not submitted in this format will be summarily rejected. Fill up the form clearly with black ink)



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