ANNEXURE

Dedicated Freight Corridor Corporation of India Limited

(A Government of India Enterprises)

(APPLICATION FORMAT)
Important Notes: (i) Before filling this form, read the instructions carefully. (ii) All entries should be made in capital letters. (iii) The Application to be made strictly in the following format and to be filled in ENGLISH Language only.

POST APPLIED FOR

(Please indicate whether Assistant Manager (Civil)/ Assistant Manager (Signal & Telecommunication)

CATEGORY
(Please indicate whether UR/ OBC / SC/ ST in the box)

SUB CATEGORY
(Please indicate whether PH in the box)

CHOICE OF EXAMINATION CITY

(please indicate in the box)

st

Preference

2nd Preference

1. Candidates Name

(in capital letters) (please keep one box blank between name, middle name & surname)

2. Father's/Husband's Name (in capital letters)

(please keep one box blank between name, middle name & surname)

3. Date of Birth :
DAY MONTH YEAR

4. Age as on 01.04.2011:
YEAR MONTH DAYS

5. Educational Qualification
Indicate Percentage of Marks for Qualification completed Degree in Civil/ E&C Percentage of Marks Post Qualification Experience in years Do you fulfill the eligibility criteria as per the Advertisement [Write: Yes/No] J & K Domicile [Write: Yes/No] Gender [Male/Female] (Please Write)

6. Nationality & Religion

7.

Are You DFCC Employee (Please tick )

Nationality Religion

YES NO

8. Application Fee: (Demand Draft in favour of DFCCIL, payable at New Delhi)

DD.No. Date Name of Bank Branch Address Branch Code Amount (Rs.)

(Candidates should write Name, Post applied for, mailing address and mobile no., in capital letters, on the reverse side of the Demand Draft)

9. Present Address of Candidate Address (in capital letters) With Black Ball Point Pen only

Name

:
Please affix one recent passport size Photograph without attestation

Fathers Name : Address : : District State : : Pin Code:

Mobile No:

Tel. NO. with STD Code:

Signature of Candidate

10.

Educational Qualification (Academic & Professional): Examination passed Name of the Institute / University Maximum Marks Year of Passing Marks Obtained %age of marks (upto 2 decimals)

11.

Post Qualification Experience starting from previous to present (Total Experience _____ Years _______Months)
Post Held with scale of pay Designation Name and Address of Employer Period of Service Total Experience in years Clearly indicate the nature of experience. Also mention the name of the project/unit where worked

From

To

12. 13.

Details of Computer Proficiency (if any) Permanent Address:

Name

:
Please affix one self attested recent passport size photograph

Fathers Name : Address : : District State : :

DECLARATION

Pin Code
DECLARATION TO BE SIGNED BY THE CANDIDATE

I hereby certify and declare that (i) I am an Indian National, (ii) I have read the provisions given in the Advertisement, (iii) All statements made and information given by me in this application are true, complete and correct to the best of my knowledge and belief. In the event of any information or part of it being found false or incorrect before or after the exam./interview or appointment, action can be taken against me by the DFCC and my candidature / appointment shall automatically stand cancelled/terminated, (iv) I further declare that I fulfill all the conditions of eligibility regarding age, educational, technical qualifications, etc. prescribed for the post applied for as on ___________________. (v) In case my application is not received by DFCC within the stipulated date due to postal delay or otherwise, DFCC will not be responsible for such delay.

14. Place:

List of Enclosures:-

Date:
(Signature of the Applicant)