DELHI PUBLIC LIBRARY

Library of National Importance

(Under Ministry of Culture, Government of India)
S.P.Mukherjee Marg, Delhi-110006

Application for the Post of _____________________________________________

Affix recent
1. IPO/DD No.____________________ dated____________ for Rs._____ (enclosed)
passport size
2. Category: OBC/SC/ST/General/PWD/XSM: photograp

3. Name of the post applied for:

4. Full name of the applicant (in block letters):

5. Fathers name (in block letters):

6. Date of Birth (in Christian Era):

7. Age (as on the closing date of receipt of Application):

8. Education Qualification:

Name of Board/ Name of Institute Year of % of marks/Div. Subjects taken

Examination passed University Passing obtained

9. Working Experience (Indication name of employer/period of service etc.)

Post Held Name of Institution/ Whether Central Period of service No. of Nature of Scale of
Department/Ministry Govt./ Completed Duties pay and
Autonomous Body/ Years & salary per
Public Months month
From To
Sector/Recognized/
Un-recognised (if
applicable)
10. Address for communication: ___________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

11. Permanent Address: ___________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

12. Nationality:

13. Xerox copies of the following documents shall be attached with the application duly attested or self-attested
(please do not attach original certificates or documents)

a) Date of Birth Certificate

b) Caste Certificate (if applicable)
c) Educational certificate(s)
d) Discharge certificate for XSM
e) Disability certificate of PWD

14. DECLARATION
I hereby declare that all the statements made in this application are true, complete and correct to the best of
my knowledge and belief. In the event of any information being found false, incorrect or ineligibility being
detected before or after the test/interview, my candidature will stand automatically cancelled.

Date: ____/____/2012 (Signature of applicant)