BARANAGAR MUNICIPAL ITY APPLICATION FORM POST APPLIED FOR ................................................... Advertisement No…………………… Date …………………. To The Chairman Attach passport Baranagar Municipality size photo duly self 87 Deshbandhu Road (E), attested Kolkata-700035, West Bengal. Name in Block letter– Shri / Smt. /Kumari ( V ) 1) 2) Father/ Husband/ Guardian’s Name- 3) Date of Birth - 4) Age as on 01.01.2019 : _____________ 5) Gender : Male Female (put ‘√’ tick mark in the box) 6) Nationality : ____________________________ 7) Religion : _______________________________ 8) Address: 9) Mobile/Contact No. __________________________________________ 10) Email Id.___________________________________________________ 11) Category: (put ‘√’ tick mark in the box) SC ST SC ST SC (EX- SC (EX- ST OBC OBC- OBC-A OBC-B (EC) (EC) Serviceman in Servicema (EX- -A B (EC) (EC) Group C post) n in Group Service D post) man in Group D post) OBC-A OBC-B Unreserved Unreserved Unreserved Unreserv Unreserved Unreserv (EX- (EX- (EC) (EX- ed (EX- persons with ed Servicem Servicema Serviceman Servicem Disabilities (meritori an in n in in Group D an in ous Group D Group D post) Group C sports post) post) post) person) 12) Academic Qualification: Sl . No. School/Board/Univ./Inst. Exam Passed Year of Total Marks Passing Marks Obtained 13) Computer Knowledge: __________________________________ 14) Experience if any : _________________________________ Declaration: I hereby declare that I have carefully read the conditions of eligibility mentioned in the advertisement. These conditions are acceptable to me and I fulfil these conditions. The details mentioned in the Application are true and I shall furnish the necessary certificates whenever required. If any information/details found to be incorrect/false at any stage of the selection process or if any fact found to have been concealed by me or detected even after the appointment, my services shall be terminated. Date: Place: Signature of the Candidate List of Documents which should be enclosed along with the application: Self Attested photo copy of all certificates attached to the application i) Proof of Age: Birth Certificate / Class X Board Exam. Admit Card / School leaving Certificate. ii) Proof of Academic qualification: Class VIII passed certificate issued by Headmaster / Headmistress / any other Certificate issued by WBBSE or any other Board or University. iii) Copy of Employment Exchange Card (Wherever Applicable) iv) Proof in support of Category (if applicable): Caste Certificate issued by competent authority. v) Proof of Typing and Computer Knowledge (if applicable): Certificate from Government recognized Institution. vi) Photo copy of EPIC / Aadhaar. .