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Pandit Deendayal Upadhyaya Institute for the Physically
Handicapped
(Ministry of Social Justice and Empowerment, Govt of India)
Department of Empowerment of Persons with Disabilities
4,Vishnu Digamber Marg, New Delhi – 110002 ,Phone-01123236207
Email : pduip.delhi@gmail.com
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Registration Number :
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Post Applied For:
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Advertisement No.
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Date of Advertisement:
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Type of Applicant :
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DD/Pay Order No.:
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Amount in Rs.:
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Name of Bank:
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Name of Applicant:
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Father's Name:
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Mother's Name:
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Date of Birth :
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Phone Nos.
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Category:
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Gender:
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Nationality:
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Mailing Address:
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Pin Code:
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Permanent Address:
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Pin Code:
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Email :
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Typing Speed :
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Shorthand Speed :
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Educational Qualifications
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Experience
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other Information :
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Declaration:
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I hereby certify that all statements made in this application are true, complete
and correct to the best of my knowledge and belief. I have read all the provisions
mentioned in the advertisement/notice carefully and I hereby undertake to abide
by them. I have also wclosed duly attested and legible copies of all the relevant
documents/certificate. The information submitted herein shall be treated as final
in respect of my candidature for the post applied for through this application form.
I understand that in the event of information being found false or declared incorrect
or incomplete at any stage prescribed in the notice or any ineligibility being detected
before or after my appointment on contract, my candidature/ selection/appointment
is liable to be cancelled/terminated automatically without notice to me and action
can be taken against me.
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Place :
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Date :
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For those applicants who are applying through proper channel:
I also declare than I have informed my Head of Office/Department in writing that
I am applying for this post (for the candidates working in Govt. Department/Autonomous
Bodies/Universities).
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Place :
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Date :
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Signature of the candidate
1. Recommendations of the employer ( to be submitted by those who are in employment
under Govt. Department/Autonomous Bodies/Universities)
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Place :
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Date :
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Signature & seal of the employer
Age limit :
Not exceeding 56 years of age as on closing date of the application.
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(Signature of Candidate with Date)
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