1. Full Name: Application for Chief Security Officer in Senior Management Grade/ Scale - V 2. Address for Correspondence: ( Please affix your recent passport size photograph and sign across ) State: Pincode 3. If you are an Employee of Bank of Baroda write E.C.No 4. Contact Details : STD code Mobile No. Residence No. Office No. E-mail ID 5. Category (SC/ ST/ OBC/ GENERAL) In case of SC/ST/OBC/candidates, name of the Caste/Tribe/Class Name of the State of Domicile : 6. Are you a person with Disability (Yes/ No) Type of Disability: VI/HI/OC Percentage of disability : 7.(a) Date of Birth (As per School Leaving Certificate SSLC/SSC) (dd/mm/yyyy) Format Age in completed years as on 01-04-2008 Years. Relaxation in age (years) Under category 8. Sex: Male /Female Page 1 of 6
9. Are you an Ex-Serviceman? YES/ NO If YES Specify: Date of Discharge : Rank at present / last held. A) Acting B) Substantive 10. Whether you belong to Religious Minority Community : (YES/NO) If yes, please state the Religion 11. Marital Status If Married, whether your spouse is working? If Yes, give details of his/her employment : 12. Father's Name Husband's Name 13. Nationality : 14. Place of Birth District State 15. Permanent address State Pincode Page 2 of 6
16. Educational and Professional Qualifications. Details of educational qualification (from matriculation/sslc/ssc onwards) (Please check eligibility in terms of minimum % of marks and Division wherever applicable.) Exams Passed Name of the Institution / University Course/ Specialisation Month, Year of Passing % of Marks Class / Grade SSC HSC Graduation Post-Grad Page 3 of 6
17. Details of Employment (Beginning with current employment) Name of the Company Designation / rank Duration From TO (mm/yyyy) No. of Years & Months Responsibilities Page 4 of 6
18.Details of registration with Professional Institutes/Bodies: (i) Name of the Professional Institute/Body Registration No Date (ii) Name of the Professional Institute/Body Registration No Date 19.Details of special training undergone related to the post applied for: Name of institute/centre Period of training No. of days From To Remarks 20. Languages Known (English, Hindi, etc..) Page 5 of 6
21. Write about 10 lines of your professional achievement relevant for the post you have applied for: Date: Place: DECLARATION Candidates Signature I hereby declare that all the statements made in this application are true, complete and correct to the best of my knowledge and belief. I understand that in the event of any information being found false or incorrect at any stage or not satisfying the eligibility criteria according to the requirements of the advertisement, my candidature / appointment is liable to be cancelled/ terminated. I am willing to serve anywhere in India. I agree that Bank has right to transfer me to any part of the country at its discretion. I hereby agree that any legal proceedings in respect of any matter(s) or claims or disputes arising out of this application and/or out of said advertisement can be instituted by me only at Mumbai and Courts/Tribunals/Forums at Mumbai only shall have sole and exclusive jurisdiction to try any cause/dispute. I undertake to abide by all the terms and conditions mentioned in the advertisement given by the Bank. Date: Place: Candidates Signature Page 6 of 6