Annexure-I

PROFORMA
Application for the post of Assistant Town Planner Gr-II
on Contract Basis in APWD, Andaman & Nicobar Administration

1.
2.

Paste here a
recent
passport size
photograph of
the applicant

Full Name of the applicant

(in block letters)
a) Name of Father

b) Name of Mother
3.

Postal
address
to
which
communication to be sent (In capital
letters).

Mobile Number
E-Mail
4.

Permanent home address (in capital/

block letters)

5.

a) Date of birth (in Christian era)

Enclose
attested
copy
of
certificate)
b) Age
as
(closing date)

on

6.

Nationality (in block letters)

7.

Gender

Date

9.

Year

28.02.2015
Years

Male
8.

Month

Months

Female

Marital status
Married
Unmarried
Details of educational qualifications:
(Give details of examination passed beginning from graduation level onwards)
(Attested copies of certificates should be attached)
Sl. Examination
Name of the
Year of
Percentage of
No
passed
Board/Institution/university
passing
Marks/Grade

Division

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10

Experience (Attested copies of certificate should be attached)

Sl
Name & Address of the
Period
Duration(in
No.
employer
months)
From
To

11.

Nature of work

Any other relevant document, in support of their 1.

candidature.
2.
3.
4.

12.

List of document enclosed.

a)
b)
c)
d)
e)
f)
g)

DECLARATION
I hereby declare that all statements made in the application are true, complete and
correct to the best of my knowledge and belief. I understand that in the event of any information
being false or incorrect detected before or after the selection my candidature / the appointment is
liable to be cancelled / terminated and in the event of any mis-statement or discrepancy in the
particulars being detected after my appointment, my services are liable to be terminated forthwith
without any notice.

Place:
Date:

Name & Signature of Candidate

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