Mgnrega Recruitment 2016 Application Form for Technical Asisstant

1. MGNREGA Recruitment 2016 APPLICATION FORM FOR TECHNICAL ASISSTANT IMPORTANT : 1.The candidate must carefully read instructions given on website www.ludhiana.nic.in before filling the form. 2.The last date of submission of application form is 12-10-2015. 3.Self attested photocopies of degree/diploma/computer course work experience should be enclosed along with the form. Latest passport size photograph pasted with gum duly signed by the candidate Applied for Post Technical Asisstant To be filled by the candidate in block letters __________________________________________________ 1.Name of the applicant 2.Father’s name __________________________________________________ 3.Mother’s name __________________________________________________ 4.Date of Birth (DD/MM/YYYY)________________________________________________ 5.Permanent Address __________________________________________________ __________________________________________________ __________________________________________________ 6.Correspondence Address__________________________________________________ __________________________________________________ __________________________________________________ 7.Telephone No. with STD code (Landline) ______________________________________ 8.Mobile No. _________________________________________________ 9.E-mail ID. 10.Gender. _________________________________________________ MALE FEMALE 11. Category (GEN/SC/ST/OBC)________________________________________________ (attach the attested copy(ies) of the relevant certificates for the category(ies) under which candidate sought in support of your claim otherwise, candidature will be cancelled)

2. 12. Eligibility Details: Examination Board/University /institution Year of passing Subjects Marks obtained/ Total marks Percentage Marks as per criteria (percentage/ 10) for degree holders (percentage/ 12.5) for diploma holder Diploma in Civil Engeneering Digree in in Civil Engeneering Computer course (Diploma holders only) Any other Place of Posting To Total Work Experience 13. Work Experience: Name of Employer Post From DECLARATION AND UNDERTAKING 1.I hereby certify that the application form has been filled in by my own hand in ink, and according to the given instructions. 2.I hereby affirm that the information given by me in this application form is complete and true to the best of my knowledge 3.I shall remain in touch with the concerned office for knowing the outcome regarding my result and shall not hold the concerned office responsible for any postal delay, loss or misplacement of the correspondence made in this regard. 4.I also affirm that in case I am found violating the above undertaking, I will be liable to be penalized, including candidature of the examination.

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