Govt.Of Nct Of Delhi Office Of The Electrical Inspector 5-Sham Nath Marg Delhi-110054
Form-A (See Condition-13)
Application For Admission To Examination Of Certificate Of Competency Class-Ii (Electrician) (To Be Filled By The Candidate In English / Hindi)
1.
Full name or the applicant(in block letters).
___________________________________________
2.
Father's name
___________________________________________
3.
Date or birth Age
___________________________________________
4.
Address (a)Residential(b) Occupational
___________________________________________
5.
Educational Qualifications
___________________________________________
6.
Details of past & present Experience in electrical trade
___________________________________________
Name of the electrical Contractor/supplier/Dept. where worked
Nature of work
Date of joining
Date of leaving
Total period
7.
Examination fee Rs.100/- to be paid in Government Treasury, Old Sectt. Delhi-110054. Paid Rs……………. vide Treasury Challan No…………………… Dated …………… …… in the State Bank of India, Old Sectt., Delhi-54.
8.
Are 2 copies of recent photographs (2"x2.1/2") with your name, father's name & signature on the back and duly attested attached.
Yes/No.
9.
If failed in previous examination of Class-II Certificate of Competency, State Here Roll No. and Year in which appeared. (a) Year……….. Roll No…………..
I do hereby declare that the particulars stated above are correct and true to the best of my knowledge and belief.
Signed in my presence By Shri………………………………….
Signature of application Date……………………………
Whose photograph is pasted on this Application is personally known to me
Signature…………………………………… Designation…………………………………
REMARKS OF BOARD OF EXAMINERS
Date & Place for Examination
Date
Place
Passed/ Failed
Personal description of applicant
Height
Finger marks Personal marks & peculiarities
Colour of
Hair
Eyes
Space
for
Photograph
I hereby certify that the particulars contained in Division' A ' & 'B' above are correct.
DATE
EXAMINER
SECRETARY/CHAIRMAN Board of Examiners, Delhi
NOTE:
a)
Attested copies of experience certificates thereof should be attached.
b)
Age proof i.e. Attested copy of Middle/ Matriculation/ Higher Secondary Certificate or an affidavit in support of the same should be attached.
c)
No payment will be accepted in cash or by cheque. Original Treasury receipt should be attached.
d)
The application must be signed in the Employer/ Magistrate/ Gazetted Officer/ Member of parliament/ Member of legislative Assembly or Municipal councilor.
e)
One recent passport size photograph duly attested may be affixed in the space prescribed above & another should be properly attached alongwith application.
f)
Two self addressed stamped envelopes of size 9" *4" should be attached alongwith the application.
TAKE NOTE:
i)
If the application is incomplete in any respect, the applicant will not be admitted to the examination.
ii)
The application received after the last date will not be accepted
iii)
Any person who makes, procures to be made or assists in making any false representation for the purpose of obtaining for himself or any other person a certificate of competency will be criminally prosecuted.
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