jiyt gjfhd zg

1. zgjhu KG bga :

(mik

2. wj nj :

vLfgl ifgl )

1. Kft:
   
   
2. ifng v.
   
   
3. mr Kft :
   
   
4. f jF : (cfSF j l njitglh, mnj tot jj jhfis jabrJ izf)
   
   
5. RUfkhd nrit tuf kW mDgt (rga gjUJ bjhlf). cfSF mf l njitglh, mnj tot jj jhfis jabrJ izf.
   
   
1. TLj tuf, gjF bghUjkhdJ VnjD Ujh
   
   
2. (ka myJ khy murh bgwgl UJ, btpL, mDgt kW gj bjhlghd gf) (njitglh TLj jhfis izf)
1. cW bkh
   
   
1. zggot Flgl Mtzf tHfgl jftf midJ rahdit vW
   
   
2. eh nj braglh, Mizaij vDila Ra yhgfhf cgnahfgLj khnl vW jehL khy kf Miza jiyt gjia cgnahfgL ntW vj gia nkbfhs khnl vW j _y cW mnw.
   
   

tir v.	gl go / gla go bga	gfiyfHf / l	fhy		Kjik ghl
			Kj	tiu

gj	Wtd	fhy		ntiy RUfkhd tu
		Kj	tiu

(zgjhu ifbahg)

l :

eh :

Application Form for the Post of Member

1. Full Name of the applicant :

Affix Recent

2. Date of Birth :

Passport size

3. Address :

Photograph

4. Whether belong to

SC/ST ;:

If Yes, sub caste (Copy of the Community Certificate to be enclosed)

1. Mobile No.
   
   
2. E-Mail ID :
   
   
3. Educational Qualification : (In case you need more space, kindly attach separate sheets in the same format).
   
   
4. Brief Service Particulars and Experience : (Starting from the most recent post. In case you need more space, kindly attach separate sheets in the same format).
   
   
5. Additional information, if any, in support of suitability for the post: (Any other National or State level Recognition/Awards won/ Publications/experience/assignments relevant to the requirements of the post applied. (Please attach additional sheets, if required)
   
   
1. It is certified that,
   
   
1. The information furnished in the application form and enclosed documents is correct.
   
   
2. If selected, I shall not hold office of profit or pursue any profession or carry on any business other than my office as Chairperson or Member, Tamil Nadu State Commission for Women.
   
   

S. No.	Name of Degree/Diploma (as printed on your certificate)	University/Place	Duration		Main Courses of Study
			From	To

Designation	Organisation	Duration	Brief
			Description of
			Duties

		From	To

(Signature of the applicant) Place :

Date :

cWd gjfhd zg

1. zgjhu KG bga :

(mik

2. wj nj :

vLfgl ifgl )

1. Kft:
   
   
1. jhjglt / gHFoduhf Ujh ;
   
   
2. M vwh, rh ............................................................................................... (rh rhj ef izfgl ntL)
2. ifng v.
   
   
3. mr Kft :
   
   
4. f jF : (cfSF j l njitglh, mnj tot jj jhfis jabrJ izf)
   
   
5. RUfkhd nrit tuf kW mDgt (rga gjUJ bjhlf). cfSF mf l njitglh, mnj tot jj jhfis jabrJ izf.
   
   
6. TLj tuf, gjF bghUjkhdJ VnjD Ujh (ka myJ khy murh bgwgl UJ, btpL, mDgt kW gj bjhlghd gf) (njitglh TLj jhfis izf)
   
   
1. cW bkh
   
   
1. zggot Flgl Mtzf tHfgl jftf midJ rahdit vW
   
   
2. eh nj braglh, Mizaij vDila Ra yhgfhf cgnahfgLj khnl vW jehL khy kf Miza cWd gjia cgnahfgL ntW vj gia nkbfhs khnl vW j _y cW mnw.
   
   

M	iy

tir v.	gl go / gla go bga	gfiyfHf / l	fhy		Kjik ghl
			Kj	tiu

gj	Wtd	fhy		ntiy RUfkhd tu
		Kj	tiu

(zgjhu ifbahg)

l :

eh :

Essential Documents to be enclosed with application form.

(Please tick the documents enclosed)

a.

Self attested copies of all degree/certificates and mark - sheets as proof of academic qualifications.

b.

Proof of Identity: (Any one of the following)

i. Adhaar Card ii. Voter ID Card iii. Valid Passport

iv.

Ration Card with Photo

v.

Driving License,

vi. PAN Card, vii. Arms License with Photograph viii. Passbook with Photograph issued by Public Sector Banks/Post Office.

ix.

Pension Documents such as Pension Book / Pension Payment Order with Photograph

x.

Disability Certificate issued by competent authority.

c.

Proof of Residence: (Any one of the following)

i. Adhaar Card ii. Voter ID Card iii. Passport

iv.

Ration Card with Photo

v.

Driving License,

vi. Arms License, vii. Property Tax Receipt viii. Telephone Bill / Electricity / Water Charges receipts

ix.

Vehicle registration certificate

x.

Current passbook of post office/Bank

d.

Documents issued by the organizations/authorities indicating experience in the relevant field.