The document outlines the application form format for recruitment at Mazagon Dock Ltd for various posts on a contract basis in 2015. It includes sections for personal information, educational qualifications, employment history, and a declaration by the candidate. Additionally, it specifies the processing fee details and requirements for submitting documentation along with the application.

1. Mazagon Dock Ltd Recruitment 2015 Application Form Format/Fee Challan
REF.NO.MDL/DIV-REC- Regi. No.75/__________
NE/75/2015
APPLICATION FOR THE POST (For Official Use only)
OF_____________________________
ON ‘ CONTRACT BASIS’
The DGM (REC-NE),
Mazagon Dock Limited PASSPORT
Dockyard Road, SIZE
Mazagon LATEST PHOTO
Mumbai-400 010
1. Name : _______________________________________________________________
(In Block Letter) First Name Middle Name Surname
2. Father’s Name: ____________________________________________
3. (a) Date of Birth: ____/____/_______ (b) Age as on 01.02.2015:____ years____ months
4.(a) Whether you belong to : (Please tick in appropriate column)
A SC ST OBC GEN
OH HH VH
B PWD (Disability more than 40 %)
Yes / No No of years service Post Held
C Whether Ex-Serviceman
(b) Name of the Caste / Tribe / Class:_______________________ Religion : _________
5. Nationality:_____________
6. Gender: Male / Female
7. Marital Status: Married / Unmarried
Signature of
Candidate
Contd....2

2. -2-
8. EDUCATIONAL QUALIFICATION:
Exam Passed Name Of Institute Year Of Subject % Of Class/Div
Passing Mark
10
th
(SSC) /
Army Class I /
Equivalent
12
th
(HSC)
Apprenticeship-
NAC
Diploma
9. (Please tick in appropriate column)
EX MDL Operative EX MDL Apprentice Outside
Apprenticeship
10.Details of previous experience and present employment in chronological order
Name of Post(s) held From To Years & Scale of Pay Nature of
Organization Months Job
(Whether
Govt./PSU/PVT)
11. Present Address Permanent Address
------------------------------------------------- -------------------------------------------
------------------------------------------------- -------------------------------------------
------------------------------------------------- -------------------------------------------
PIN CODE: _______________________ PIN CODE: _______________________
12. Telephone No. Resi.___________________ Mobile ________________________
13. Nearest Railway Station : ________________________________________
14. Employment Exchange Regd. No & Validity(If any): ___________________________
15. ESIC ( IP ) No : ___________________________
Signature of Candidate
Contd.....3

3. -3-
16. Details of father/mother if employed in Mazagon Dock Ltd.
Name of Father/Mother Department Ticket No Post held
17. List of attested photocopies of the document attached:
 Proof of Date of Birth. 
 SSC Marksheet / SSC Board Certificate/ VIIIth Marksheet 
 NAC /Diploma/Degree Certificate. 
 Mark sheet of NAC/Diploma/Degree. 
 Experience Certificate. 
 Caste Certificate (if applicable)/Caste Validity Certificate / Non-creamy layer certificate for OBC. 
 Certificate of Disability from competent Authority indicating 40% or more disability in
HH/OH Category. 
 NOC (if working in Govt./PSU). 
 Discharge Certificate from Defence Services (for Ex-serviceman). 
 Driving Licence(if applicable) 
 Any other. 
18. Declaration : I_______________________________________ hereby certify that all information
given in this application is true, complete and correct to the best of my knowledge and belief. I have
not suppressed any material fact or factual information in the above statement. I am aware that in
case I have given wrong information or I do not fulfill the criteria according to the advertisement, my
candidature may be rejected / service terminated without giving any notice or reasons or
compensation therefore. Further I have remitted Rs.________to MDL A/C No.34413274176, Challan
copy enclosed herewith.
Signature of the Candidate
Date : ____________________
Place:_____________________
( For Office use only )
Status : Eligible / Not-eligible: (Reason)__________________________________
Signature of the officer
Name :___________________________
Designation_______________________
Complete Job Details Of This Recruitment@ http://bharatrecruitment.com/mdl-recruitment/454

4. Bank’s MDL’s Applicant
Copy Copy Copy
STATE BANK OF INDIA STATE BANK OF INDIA STATE BANK OF INDIA
Challan for remittance of Processing Fee for Mazagon Challan for remittance of Processing Fee for Mazagon Challan for remittance of Processing Fee for Mazagon
Dock Ltd, Mumbai Dock Ltd, Mumbai Dock Ltd, Mumbai
Advertisement No. 75 Advertisement No. 75 Advertisement No. 75
MDL A/C No. 34413274176 MDL A/C No. 34413274176 MDL A/C No. 34413274176
At SBI Code No: 09054 At SBI Code No: 09054 At SBI Code No: 09054
Details to be filled by the Applicant Details to be filled by the Applicant Details to be filled by the Applicant
Mr./Ms._____________________________________ Mr./Ms.____________________________________ Mr./Ms._____________________________________
____________________________________ _____________________________________ ____________________________________
Date of Birth: Date of Birth: Date of Birth:
(DD/MM/YY) (DD/MM/YY) (DD/MM/YY)
Position Applied for: Position Applied for: Position Applied for:
Details to be filled by Branch Details to be filled by Branch Details to be filled by Branch
Branch Name : Branch Name : Branch Name :
Branch Code : Branch Code : Branch Code :
Journal No. : Journal No. : Journal No. :
Date of Remittance : Date of Remittance : Date of Remittance :
Employment Application Fee : Rs. 100/- Employment Application Fee : Rs. 100/- Employment Application Fee : Rs. 100/-
Bank Charge : Rs. 40/- Bank Charge : Rs. 40/- Bank Charge : Rs. 40/-
Total Payable : Rs. 140/- Total Payable : Rs. 140/- Total Payable : Rs. 140/-
Signature of the Signature of the authorized Signature of the Signature of the authorized Signature of the Signature of the authorized
Remitter Official with Branch Seal Remitter Official with Branch Seal Remitter Official with Branch Seal
For the Fee receiving Branch of SBI For the Fee receiving Branch of SBI For the Fee receiving Branch of SBI
Branch should collect Rs. 40 extra (total of Rs. 100 + Rs. Branch should collect Rs. 40 extra (total of Rs. 100 + Rs. Branch should collect Rs. 40 extra (total of Rs. 100 + Rs.
40=Rs.140/-) from the remitter as bank charges and to be 40=Rs.140/-) from the remitter as bank charges and to be 40=Rs.140/-) from the remitter as bank charges and to be
credited to the branch commission account, in accordance credited to the branch commission account, in accordance credited to the branch commission account, in accordance
with CGM, Mumbai sanction Ref. No. SME/1/1071 dt. with CGM, Mumbai sanction Ref. No. SME/1/1071 dt. with CGM, Mumbai sanction Ref. No. SME/1/1071 dt.
15.03.2014 15.03.2014 15.03.2014
2. Branch should write the Branch Name, Branch Code, 2. Branch should write the Branch Name, Branch Code, 2. Branch should write the Branch Name, Branch Code,
Journal No. & Date of remittance invariably and hand Journal No. & Date of remittance invariably and hand Journal No. & Date of remittance invariably and hand
over both the MDL’s copy & Applicant’s copy to the over both the MDL’s copy & Applicant’s copy to the over both the MDL’s copy & Applicant’s copy to the
remitter duly signed. remitter duly signed. remitter duly signed.