advertisement

1. APPLICATION FORM
1.
Post applied for
(candidate shallclearly indicates the name ofposts forinterview) RA-I
2. Advertisement No. & Date
3. Name of the candidate (In Block letters) DR. BISHNU PRASAD SAHOO
4. Father/Husband’s name
Braja Kishore Sahoo
5. Date of Birth (in Christian era)
21.03.1989
Age in Years,Months & Days
29 years 11 months 5 days
6.
Whether belongs to SC/ST/OBC/UR/PwD/
Ex-service Man
OBC
7. Nationality
Indian
s. Present PostalAddress with pin code For Correspondence
in block letters
Central Pollution Control Board
Southernd Conclave, Block 502, 5th and 6th Floors, 1582 Rajdanga Main Road,
Kolkata
PIN No. : 700107
State : West Bengal
9. Mobile
+919777152627 or +919337297519
10.E-mail ID
bishnu89sm@gmail.com
Contd,..2
Affix
Passport Size
Photograph

2. IL Educational Qualifications (10 class onwards)
(self-attested ofphotocopy ofMark-sheetsand certificates shouldbe attached with this form)
SI.
No.
Name of the
Examination passed
Year of
Passing
Name of the
Board/University
% of
Marks Division
Subject/Discipline in
Engineering or
Science/Other
1
Matriculation
Intermediate
12. Details of Employment (Work Experience) and also enclosed certificates from employer, if any.
Name of the
Office/lnstt./Orgn.
Post held From To
Pay Band
with
Grade Pay
And Basic
Pay
Nature of Duties
" * •< i •
Total Experience in Years/Months/Days
13. Additional information, if any, which you would like to
mention in support of your suitability for the post.
Enclose a separate sheet if the space is insufficient.
Declaration
I affirm that information given in this application is true and correct. 1 also 1’ully understand that if at
any stage it is discovered that any attempt has been made by me td conceal wilfully or misrepresent the fact(s),my
candidature may summarily be rejected or employment terminated.
Place ..................
Date ...................
Signature of the Candidate

3. ADMIT CARD (Candidate copy)
Affix
Passport Size
Photograph
1. Name
2, Full Address for correspondence
3. Post applied for
4. Registration No.
(SI. No. 4, to be filled by Office)
(Signature of Applicant)
ADMIT CARD (Office Copy)
Affix Passport Size
Photograph
1. Name
2. Full Address for correspondence
3. Post applied for
4. Registration No.
(SI. No. 4, to be filled by Office)
(Signature of Applicant)
Note: -hi case application form is incomplete or without, photographs, will be rejected summarily.

4. w
E[pEQ)
APPLICATION FORM
Affix
Passport Size
Photograph
1.
Post applied for
(candidate shallclearly indicates the name ofposts forinterview. Scicntist-B
2.Advertisement No. & Date
3.Name of the candidate (In Block letters)
4.Father/Husband’s name
5.Date of Birth (in Christian era)
Age in Years,Months & Days
6.
Whether belongs to SC/ST/OBC'/UR/PwD/ Ex-service
Man
7.Nationality
8.Present PostalAddress with pin code For correspondence
in block letters
PIN No. :
State :
9.Mobile
10.E-mail ID
Contd...2

5. II. Educational Qualifications (10 class onwards)
(self-attested ofphotocopy ofMark-sheetsand certificates shouldbe attached with this form)
SI.
No.
Name of the
Examination passed
Year of
Passing
Name of the
Board/University
% of
Marks Division
Subjcet/Discipline in
Engineering or
Sciepce/Other
12. Details of Employment (Work Experience) and also enclosed certificates from employer, if any.
Name of the
Office/Instt./Orgn,
Post held From To
Pay Band
with
Grade Pay
And Basic
Pay
Nature of Duties
Total Experience in Years/Months/Days
13, Additional information, if any, which you would like to
mention in support of your suitability for the post.
Enclose a separate sheet if the space is insufficient.
Declaration
I affirm that information given in this application is true and correct. I also fully understand that if al any
stage it is discovered that any attempt has been made by me to concealwilfully or misrepresent the fact(s),my
candidature may summarily be rejected or employment terminated.
Place ..................
Date ...................
Signature of the Candidate

6. ADMIT CARD (Candidate copy)
Affix Passport Size
Photograph
1. Name
2, full Address for correspondence
•
3. Post applied for
4. Registration No.
(SI. No. 4, to be tilled by Office)
(Signature of Applicant)
ADMIT CARD (Office Copy)
Affix Passport Size
Photograph
1. Name
2.Full Address for correspondence
3. Post applied for
4. Registration No.
(SI. No. 4, to be filled by Office)
(Signature of Applicant)
/Vote: - In case application form is incomplete or without, photographs, will he rejected summarily.

7. APPLICATION FORM
Affix Passport Size
Photograph
I
Post applied for
(candidate shallclearly indicates the name ofposts forinterview) Senior Research Fellow (SRF)
2. Advertisement No. & Date
3. Name of.the candidate (In Block letters)
4. Father/Husband’s name
5. Dale of Birth (in Christian era)
Age in Years,Months & Days
6.
Whether belongs to SC/ST/OBC/UR/PwD/ Ex-service
Man
7. Nationality
8. Present PostalAddress with pin code For correspondence
in block letters
PIN No. :
State :
9. Mobile
10.E-mail ID
Contd...2

8. 11, Educational Qualifications (10 class onwards)
(self-attested ofphotocopy ofMark-sheetsand certificates shouldbe attached with this form)
SI.
No.
Name of the
Examination
passed
Year of
Passing
Name of the
Board/University
% of
Marks Division
Subject/Discipline in
Engineering or
Science/Other
12, Details of Employment (Work Experience) and also enclosed certificates from employer, if any.
Name of the
Office/Instt./Orgn.
Post held From To
Pay Band
with Grade
Pay And Basic
Pay
Nature of Duties
Total Experience in Years/Months/Days
13. Additional information, if any, which you would like to
mention in support of your suitability for the post.
Enclose a separate sheet if the space is insufficient.
Declaration
1 affirm that information given in this application is true and correct. I also fully understand that il at any
stage it is discovered that any attempt has been made by me to conceal wilfully or misrepresent the fact(s), my
candidature may summarily be rejected or employment terminated.
Place ..................
Date ...................
Signature of the Candidate

9. ADMIT CARD (Candidate copy)
Affix
Passport Size
Photograph
1. Name
2.
Full Address for correspondence
* • • •
3. Post applied for
4. Registration No.
(SI. No. 4, to he filled by Office)
(Signature of Applicant)
ADMIT CARD (Office Copy)
Affix Passport Size
Photograph
1. Name
2 Full Address for correspondence
3. Post applied for
4. Registration No.
(SI. No. 4, to be filled by Office)
(Signature of Applicant)
/Note: - In case application form is incomplete or without, photographs, will he rejected summarily.