Recruitment Form Post Applied For Option 1 Advertisement No Eligliblity Name of Applicant Father’s Name Mother Name Are you Domicile of Haryana: YesNo Category GeneralOBCEWSSC/ST Date Aadhar Card Nationality Visible Identification Mark Text Text Email Mobile Is the applicant Orphan YesNo Are you working with any state Govt. or Govt. of India or PSU?: YesNo Is candidate sons/daughters of ESM of Haryana? YesNo Are you Ex-servicemen of Haryana?: YesNo Are you Person with Disabilities (PWD)/Physically Handicapped (PH) of Haryana?: YesNo Marital Status MarriedUnmarried Is candidate children and the grand children of Freedom Fighters (DFF) of India?: YesNo Is Applicant’s father, mother, spouse, brothers, sisters, sons and daughters is, was or has been a regular employee in any Department/Board/Corporation/Company/statutory Body/Commission/Authority of Govt. of Haryana or any other State Government or Govt. of India?: YesNo Are you belong to denotified tribe (Vimukt Jatis and Tapriwas Jatis) or Nomaidic tribe of Haryana which is neither a Scheduled Caste nor a Backward Class?: YesNo Fee Receipt No Matriculation Amount Name of Bank Year of Passing date of Deposite University/Board Mode of Payment Marks Obtain Total Marks Percentage Senior Secondary Year of Paasing University /Board Marks Obrain Total marks Percentage Graduation Year of Passing University/Board Marks Obtain Total Marks Percentahe Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Work Experience Name of Employer Type of Employment Post Held Pay Scale Period of Employment (From) Period of Employment (To) Nature of Duties plus1 Add minus1 Remove Declaration1. I declare that the information given/statements made by me in this aplication are true, complete and correct to the best of my knowledge and belief and nothing has been concealed or suppressed. In the event of any information being found false or incorrect or is not in conformity with the eligibility criteria mentioned in the advertisement at any point of time my candidature/appointment may be cancelled/terminated without any notice and/or I shall be liable for any other action under the extent rules.2. I hereby declare that all the attachment uploaded by me is correct and I will submit all documents or any other relevant documents to CBLU, Bhiwani at the time of Document Verification/Scrutiny. Agree Disagree If you are human, leave this field blank. Submit
