Recruitment Form Post Applied For Option 1 Advertisement No Eligliblity Name of Applicant Father’s Name Mother Name Are you Domicile of Haryana: Yes No Category General OBC EWS SC/ST Date Aadhar Card Nationality Visible Identification Mark Text Text Email Mobile Is the applicant Orphan Yes No Are you working with any state Govt. or Govt. of India or PSU?: Yes No Is candidate sons/daughters of ESM of Haryana? Yes No Are you Ex-servicemen of Haryana?: Yes No Are you Person with Disabilities (PWD)/Physically Handicapped (PH) of Haryana?: Yes No Marital Status Married Unmarried Is candidate children and the grand children of Freedom Fighters (DFF) of India?: Yes No 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?: Yes No 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?: Yes No 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 Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Work Experience Name of Employer Type of Employment Post Held Pay Scale Period of Employment (From) Period of Employment (To) Nature of Duties Add 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
