BARODA RAJASTHAN KSHETRIYA GRAMIN BANK CHECK LIST FOR PERSONAL FILE

Transcription

1 BARODA RAJASTHAN KSHETRIYA GRAMIN BANK (HEAD OFFICE : AJMER) CHECK LIST FOR PERSONAL FILE I (Name) ROLL NO. : Id: Personal Mobile No: Caste/Category: (SC/ST/OBC/PC/EXS/Others) PWD % OF DISABILITY Provisionally allotted for the post of Office Assistant (M)/ Officer Scale-I / Officer Scale- II (GBO / IT / CA ) / Officer Scale III, reported at Baroda Rajasthan Kshetriya Gramin Bank, Head office, Ajmer for Pre-Joining formalities and submitted following Forms/ Documents duly attested by me. NAME OF CERTIFICATE/DOCUMENT MARK ( ) by 1 Date Of Birth Certificate Candidate MARK ( ) or Comments of Verifying Officer 2 Educational Qualification Certificates 3 S.S.C. 4 H.S.C. 5 Graduation Post-Graduation Others 6 Hindi Language (As one of the subject in above Educational Certificate) 7 Computer Literacy Certificates/ one of the subject in above Educational Qualifications 8 Experience Certificate 9 Caste Certificate (For SC/ST/OBC Candidates) 10 OBC Creamy Layer Clause In Certificate 11 Medical Certificate From Medical Board (For PC Candidates) 12 Satisfactory Report / Character Certificate (From two Authority) 13 Discharge Certificate (For Ex-Servicemen) 14 ID Proof 15 CRP RRB VI Score Card/ Combine Result with Allotted Bank Name Issued by IBPS 16 Passport Size Photograph Four 17 NOC/ Relieving Order issued by Present Employer 18 IBPS Application Form 19 Copy of Pre Recruitment Formalities Call Letter 20 Police Verification Report

2 Form No. Pre Recruitment Formalities Form MARK ( ) by F-1 Service Entry Cum Bio-Data Form Candidate MARK ( ) or Comments of Verifying Officer F-2 Declaration By SC/ST/OBC Candidates F-3 Declaration Of Marital Status (Schedule-I) F-4 Declaration On Fidelity & Secrecy (Schedule-II) F-5 Declaration Of Domicile (Schedule-III) F-6 Undertaking (For Ex-Serviceman) F-7 Letter Of Undertaking (At the time of Reporting) F-8 Report Of Referees F- 8 1 F-9 F-10 F-11 F-12 Individually filled by two Referees Identity Form Attestation Form Place: Signature Of Candidate Date : NAME Signature Of Verifying Officer NAME Place: E.C. NO. Date : DESIGNATION

3 BARODA RAJASTHAN KSHETRIYA GRAMIN BANK (HEAD OFFICE : AJMER) F-1 lsok izfof V,oa ckw;ksmsvk QkWeZ SERVICE ENTRY CUM BIO-DATA FORM 1. (a) iwjk uke ¼cM+s v{kjksa es a½ Full Name (IN BLOCK LETTERS) : (b) firk dk uke Father s Name : 2. orzeku irk Present Address : LFkk;h irk Permanent Address : 3. tue rkjh[k Date of Birth : 4. oxz lkeku; v-tk- vttk v-fi-o- fodykax HkwiwZolSfud Category : (a) Gen SC ST OBC PC XSM 5. inuke Designation : 6. Js.kh@osrueku Grade / Scale : 7. ifjokj ds lnl;ksa dk C;kSjk % Details of family members : uke Name fj rk Relation mez Age vkfjr Whether dependent (Y / N) O;olk; dk C;kSjk Details of occupation ekfld osru Salary per month (Rs.) 8. igpku dk fpug Identification Mark 9. D;k vki csad ds fdlh funs kd ;k dezpkjh ds fj rsnkj gs \ ;fn gks] d`i;k,sls O;fDr dk iwjk C;kSjk] csad esa mldh gsfl;r rfkk D;k fj rk gs] ;g n kkz,a Are you a relative of any Director or the employee of the Bank? If so, please give the full name of such person, his position in the Bank & : : nature of relationship. 10. ewy fuokl dk LFkku Place of Domicile : 11. vius ks{kf.kd dk;zdky ds nksjku ;fn vkius dksbz O;ogkfjd izf k{k.k fy;k gks] rks mldk C;kSjk nsaa Give details of any practical training : you had as a part of your academic career / training..2

4 F D;k vkidks fdlh izdk ku dk Js; feyk gs\ ¼isilZ] ys[k br;kfn½ ;fn gks] d`i;k C;kSjk nsaa Have you any publication to your credit (Papers, articles, etc.)? If so, please give details. 13. D;k vki vkxs fdlh ikb~;øe gsrq v/;;u dj jgs gsa\ ;fn gkwa] d`i;k C;kSjk nsaa Are you studying for any further course? If so, please give details. 14. D;k vki fdlh fudk;ks a ds lnl; gs\ ;fn gkw] d`i;k C;kSjk nsaa (2) : : Are you, a member of any professional /: political body / bodies? If yes, please give details. 15. D;k vkius fons k ;k=k dh gs@;fn gks]] d`i;k mldk m)s ;] vkids fons k esa jgus dh vof/k rfkk dksbz vuqhko vftzr fd;k gks] rks mldk C;kSjk nsaa Have you traveled abroad? If so, : please give details about the purpose, duration of your stay abroad, any experience gained etc. 16. D;k vki dhkh fxj rkj gq, gsa vfok vfhkj{kk esa j[ks x, gsa vfkok fdlh U;k;ky; }kjk vkc) fd;s x, gsa vki ij tqekzuk yxk;k x;k gs ;k fdlh ijh{kk es a csbus ij jksd yxk;h x;h gsa vki v;ksx;?kksf kr fd;s x, gs vfkok fdlh izkf/kdkjh@lalfkku }kjk dksbz izfrca/k yxk;k x;k gs\ ;fn gkwa] rks iw.kz nsaa Have you ever been arrested or kept : under detention or bound/fined/ convicted by court of law or debarred/ disqualified from any examination or restricted by any authority / Institution? If yes, give full details. 17. vu; dksbz lwpuk tks vki nsuk pkgs aa Any other information you would like : to give. 18. esa fdlh Hkh LFkku ij tgkwa csad dh kk[kk ;k dk;kzy; gs ;k vc ds ckn [kksyh tk,] esa csad dh lsok djus gsrq bpnqd gwa vksj esa csad }kjk le; ij r; dh tkrh lsok krksza ls vkc) jgus gsrq lger gwaa esa uksv djrk gwaw] fd ifjoh{kk dh vof/k ds nksjku esjh lsok,a csad }kjk fcuk fdlh dkj.k n'kkz, lekir dh tk ldsxha I am willing to serve the Bank anywhere the Bank has or might hereafter open office or branches and agree to be bound by the terms and conditions of services laid down by the Bank from time to time.i note that during the period of probation, my services are liable to be terminated by the Bank without assigning any reason whatsoever for such termination...3

5 F-1 (3) esa,rn~}kjk lger gksrk gwa] fd eq>s vkids }kjk lsok es a fy;s tkus ij] csad ;k mlds xzkgdksa ds ekeyksa ls lacaf/kr dksbz Hkh tkudkjh esjs ikl gksxh] mls esa vr;ur xksiuh; j[kwaxk vksj fdlh Hkh le; fdlh ds le{k mls izdv ugha d:axka I hereby agree that in the event of my being taken up in your services, any information concerning the affairs of the Bank or its clients of which I may become possessed, shall be held by me in strict confidence and shall not be divulged to anyone at any time. esaus mdr QkWeZ rfkk ckw;ksmsvk QkWeZ Hkjk gs vksj esaus ml ij lko/kkuh ls fopkj djrs gq, vksj le> dj opu fn;k gs rfkk,rn~}kjk Hkh esa?kksf kr djrk gwwa] fd esjs mdr nksuksa izksqkwekz esa nh tkudkjh lr; gs rfkk esjh tkudkjh,oe~ fo okl ls lgh gsa I have filled in the above form and have given the undertaking after carefully considering and understanding it and I hereby declare that the information given by me in both these forms is true and correct to the best of my knowledge and belief. esa vkxs bl ckr ds fy, Hkh lger gwwa] fd esjs }kjk mdr QkWeZ rfkk ckw;ksmsvk QkWeZ esa nh xbz] ftl tkudkjh ds vk/kkj ij csad }kjk esjh fu;qfdr dh xbz gs] og xyr ik;h tkrh gs] rks mls,d xahkhj dnkpkj ekuk tk,xk vksj blls csad esa esjh lsok,a] rrdky c[kkzlr dh tk ldsxha I further agree that in the event of any information given by me in the above form and biodata form, on the basis of which my appointment is considered by the Bank, is found to be false, it will constitute serious misconduct which will render me liable to immediate dismissal from the Bank s service. LFkku % Place : fnukad % Date : Signature iwjk uke % Full Name : eksckbzy ua-: bz&esy irk:

6 DECLARATION TO BE SIGNED BY SC/ST CANDIDATES ONLY F-2(SC/ST) I_son/daughter/wife of resident of village/town/city district state hereby declares that I belong to the community which recognized as Scheduled caste / Scheduled Tribe by the Government of India for the purpose of reservation in Central Government Services under various constitutional orders. It is also declared that the caste certificate submitted by me shall be deemed to be material for the purpose of this appointment. If the any information contained in the Caste Certificate is found false or incomplete my services are liable to be terminated at any point of time as appointment having been secured on misrepresentation/ supersession. Place: Date : Signature of the Candidate (Name ) Mobile No.

7 F-2(OBC) DECLARATION TO BE SIGNED BY OBC CANDIDATES ONLY I_son/daughter/wife of shri resident of village/town/city district state hereby declares that I belong to the community which recognized as a backward class by the Government of India for the purpose of reservation in Services as per orders contained in Deptt. of Personnel and Training Office Memorandum No /22/93-Estt. (SCT) dated It is also declared that I do not belong to the persons/sections (creamy layer) mentioned in Column 3 of the schedule to the OM No-36102/22/93-Estt (SCT) dated and modified vide Govt. of India Deptt. Of Personnel and Training OM No /3/2004-Estt (Res) dated It is also declared that the caste certificate submitted by me shall be deemed to be material for the purpose of this appointment. If the any information contained in the Caste Certificate is found false or incomplete my services are liable to be terminated at any point of time as appointment having been secured on misrepresentation/ supersession. Place: Date : Signature of the Candidate (Name ) Mobile No.

8 SCHEDULE I F-3 [See regulation 5(4)(ii)] DECLARATION OF MARITAL STATUS I, Shri/Smt/Kum s/o w/o d/o declare as under: (i) (ii) (iii) That I am unmarried/a widower/widow. That I am married and have only one spouse living. That I have entered into or contracted a marriage with a person having a spouse living. I may be granted exemption on the basis of ground given below. Application for grant of exemption is enclosed. Ground: 2. I solemnly affirm that the above declaration is true and I understand that in the event of the declaration being found to be incorrect after my appointment, I shall be liable to be dismissed from service. Date: Place : Signature of Candidate

9 SCHEDULE - II F-4 (See regulation 19) DECLARATION OF FIDELITY AND SECRECY I,, do hereby declare that I will faithfully, truly and to the best of my skill and ability execute and perform the duties required of me as officer or employee of the Baroda Rajasthan Kshetriya Gramin Bank and which properly relate the office or position held by me in the said Bank. I further declare that I will not divulge or allow to be divulged to any person not legally entitled thereto any information relating to the affairs of the said Bank or to the affairs of any person having any dealing with the said Bank and nor will I allow any such person to inspect or have access to any books or documents or electronic records belonging to or in possession of the said Bank and relating to the business of the said Bank or the business of any person having any dealing with the said Bank. Signature: Place : Date : Name in full: Designation: Signed before Verifying Officer Signature: Name in full: Designation: E.C.No. :

10 SCHEDULE III F-5 (See regulation 73) DECLARATION OF DOMICILE I, the undersigned having been appointed in the service of the...bank hereby declare...(place) in...(district) as my place of domicile. 1. * The above is my place of birth. or * The above is not my place of birth. my place of birth is...(place) in...(district) but...(place) has been declared as my place of domicile for the reasons given below Date : Signature : Place : Name : Designation : * Strike out whichever is not applicable.

11 UNDERTAKING F-6 (FOR EX-SERVICEMAN) I confirm that I am entitled to the benefits admissible to ex-servicemen in terms of the Ex-Servicemen (Re-employment in Central Civil Services and Posts) Rules, 1979, as amended from time to time and I have been duly released/retired/discharged from the Armed Forces on (copy of discharge book enclosed). 2. I confirm that I have not at any time prior to this appointment, secured any employment on the civil side (including Public Sector Undertakings, Autonomous Bodies/Statutory Bodies, Nationalized Banks, etc.), by availing of the concession of reservation of vacancies admissible to Ex-servicemen. 3. I understand that if my above claim is false my services will be terminated forthwith without assigning any further reasons and without prejudice to such further action as may be taken under the provisions of Indian Penal Code (IPC) for submitting false undertaking. Place : Date : Signature of candidate Name : Address :

12 Letter of Undertaking F-7 I, S/o. R/o.(Res.Add) refer to your letter No. HO/ /HRM/ dated advising me about my appointment as Office Assistant (Multipurpose)/ Officer Scale I/ Officer Scale II(GBO/ IT/CA) / Officer Scale III. I understand that the offer made to me is provisional & subject to 1. Fulfilling all the prescribed eligibility criteria. 2. My being found medically fit and 3. Submission of various documents / certificates and mentioned in the offer letter. The said documents submitted by me shall be deemed to be material for the purpose of this appointment. I hereby state that I fulfill the prescribed eligibility criteria and all the copies of documents / certificates submitted by me are correct and in order and shall be deemed to be material for the purpose of selection. I undertake that the documents, information, statements and claims are true to best of my knowledge. In case, any thing is found to be false and/or incomplete resulting in nonfulfillment of eligibility criteria as prescribed, my candidature / appointment would be treated as void ab-initio and the services are liable to be terminated, as having been secured on mis-representation, false representations and / or suppression of facts with a motive to gain employment. Signature of the Candidate (Name ) Place: Date :

13 F-8 BARODA RAJASTHAN KSHETRIYA GRAMIN BANK HEAD OFFICE: AJMER Report of Referees Name of Post: Name of the Candidate: Father s Name: Please furnish Name and Address of two respectable persons, preferably known to the Bank and not related to you for reference :- (1) Mobile No. (2) Mobile No. Place : Date : Signature of candidate Name : Address :

14 F8 1 izek.k i= (jsqjh dh fji VZ) izekf.kr fd;k tkrk gs fd Jh@Jherh@dq iq=@iruh@iq=h fuoklh d esa finys o k ± ls Hkyh HkkfUr tkurk o igpkurkk gw o budh igpku dh iqf V djrk gw I budk pfj= mrre gs I *uke& *O;olk; & izekf.krdrkz d glrk{kj *leiw.kz irk & *e ckby la0& *;g vfuok;z lwpuk,a gsa ftudk Hkjk tkuk vko ;d gs rfkk izekf.krdrkz O;fDr ¼jsQjh½ ds igpku o irk lecu/kh izek.k tsls& vk/kkj dkmz] ikli VZ] Mªkbfoax ykblsul ;k Q V yxh csad ikl cqd dh Loizekf.kr dkih layxu g uk vko ;d gs

15 BARODA RAJASTHAN KSHETRIYA GRAMIN BANK HEAD OFFICE: AJMER F-9 1. Full Name: 2. Designation: 3. Qualification: 4. Father s Name and Occupation: 5. Caste: 6. Complete Home Address: IDENTITY FORM Affix passport size photograph duly attested 7. Present Address: 8. Mobile No. : 9. Address : 10. Date of Birth : 11. Height : 12. Mark of Identification: 13. Relationship with any employee or Director of the Bank (give names and relationship in vernacular) 14. Left hand thumb impression: 15. Signature of employee: 16. Initial of the employee: Place: Date: Signature and Designation of the Verifying Officer

16 BARODA RAJASTHAN KSHETRIYA GRAMIN BANK (HEAD OFFICE : AJMER) lr;kiu QkWeZ ATTESTATION FORM F-10 d-dw-la- EC No.: lr;kiu QkeZ esa xyr lwpuk nsuk ;k rf;kred lwpuk dks nckdj j[kuk meehnokj dks v;ksx;?kksf kr dj ldrk gs vksj,slk gksus ij meehnokj dks csad es a fu;qfdr ds fy, v;ksx; Bgjk;k tk ldrk gsa ;fn lr;kiu QkWeZ es a xyr lwpuk nh xbz gs ;k rf;kred lwpuk dks nckdj j[kk x;k gs vksj ;g rf; fdlh O;fDr ds lsok ds le; /;ku es a vkrk gs] rks mldh lsok lekir dh tk ldrh gsathe furnishing of false information or suppression of any factual information in the attestation form would be disqualification and is likely to render the candidate unfit for appointment in the Bank. If the fact that false information has been furnished or there has been suppression of any factual information in the attestation form comes to notice any time during the service of a person, his/her service would be liable to be terminated. 1 iwjk uke ¼cM+s v{kjksa esa½ miuke ds lkfk fy[ksa] SURNAME NAME ;fn dksbz gs ¼;fn vkius fdlh Hkh Lrj ij dksbz uke ;k miuke tksm+k gs ;k NksM+k gs] rks d`i;k myys[k djsa½ Name in full (in Block Capital) with aliases, if any (Please indicate if you have added or dropped at any stage any part of any name or surname) 2 iwjk orzeku irk ¼vFkkZr xkao] Fkkuk vksj ftyk ;k edku la- vksj kgj½ Present address in full (i.e. Village, Thane and District or House No. Lane/ Street/Road and Town) 3. ¼d½ iwjk LFkk;h irk ¼vFkkZr xkao Fkkuk vksj ftyk ;k edku la- ykbu@lvªhv@jksm kgj vksj ftys dk eq[;ky; dk uke½ (a) Permanent Address in full (i.e. Village, Thane and District or House No. Lane/ Street/Road,Town and name of the Distt. H.Q. ¼[k½ vxj ewy :i ls Hkkjr ds vykok fdlh vu; ns k ds fuoklh gsa] rks ml ns k dk irk vksj Hkkjrh; la?k esa LFkkukUrj.k dh rkjh[k (b) If originally a resident of country other than India, the address in that country and the date of migration to Indian Union. 4. mu LFkkuksa ds fooj.k ¼fuokl dh vof/k lfgr½ tgka vki finys ikap o kksza ds nksjku,d ls vf/kd o kksza rd jgs gsaa Particulars of places (with period residence) where you have resided for more than one year at a time during the preceding five years. ls rd From To iwjk fuokl dk irk ¼vFkkZr xkao] Fkkuk vksj ftyk edku la[;k ds fy, ykbu@lvªhv@jksm+ vksj kgj½ Residential Address in full (i.e. Village, Thane & Dist. for House No. Lane/Street/Road and Town) Affix passport size photograph iwozorhz dkwye es a mfyyf[kr LFkku ds ftyk eq[;ky; dk uke Name of the Distt. Headquarters of the place mentioned in the preceding column.. 2

17 (2) 5.1 ¼d½ firk dk iwjk uke miuke ds lkfk] ;fn dksbz gks rks (a) Father s Name in full with alias, if any ¼[k½ orzeku Mkd irk ¼vxj e`r;q gks xbz rks vafre irk½ (b) Present Postal Address (If dead, give last address) ¼x½ LFkk;h irk (c) Permanent Address : : : : ¼?k½ is kk (d) Profession ¼M-½ vxj lsok esa gs] rks inuke vksj dk;kzy; irk : (e) If in service, give designation and official address 5.2 ¼d½ ifr@ifru dk iwjk uke (a) Spouse s name in full ¼[k½ is kk (b) Profession ¼x½ inuke vksj dk;kzy; irk (c) Designation and Office Address : : : 6. Nationality of ¼d½ Father : ¼[k½ (b) Mother : ¼x½ ifr@ifru (c) Spouse : 7. ;FkkZr tue frffk Exact date of Birth : orzeku Present Age : esvªhd ds le; vk;q Age at Matriculation : 8. ¼d½ tue LFkku (a) Place of Birth : ¼ftyk vksj jkt; tgak flfkr gs½ (Distt. & State in which situated) ¼[k½ ftyk vksj jkt; tgak ds jgus okys gks (b) Distt. & State to which you belong : 9. ¼d½ vkidk /kez (a) Your Religion : ¼[k½ D;k vki vuq-tkfr@vuq-tutkfr ds lnl; gs\ vxj mrrj gkwa gs] rks bldk uke crk,a (b) Are you a member of a Scheduled Caste /: Scheduled Tribe? If the answer is yes, state the name thereof. 10. ks{kf.kd ;ksx;rk,a] ftles a 15 lky dh vk;q ls ysdj f k{kk dk LFkku o o kksza ds lkfk Ldwy vksj dkwyst dk LFkku n kkz;k x;k gksa Educational qualifications showing place of education with years in Schools and Colleges since 15 th year of age. ¼iwjs irs ds lkfk½ Ldwy@dkWyst Name of School/College with full address izos k djus dh rkjh[k Date of entering NksM+us dh rkjh[k Date of leaving mrrh.kz djus dk o kz Year of Passing F

18 11. ;fn vki fdlh Hkh le; lsok esa jgs gsa] rks mldk fooj.k nsaa If you have, at any time, been employed, give details. /kkfjr in dk uke] fu ikfnr dk;z Designation of post held of description of work From vof/k Period (3) dk;kzy;] O;olk; izfr Bku ;k lalfkku dk iwjk irk Full address of the Office, Firm or Institution F-10 lsok dks NksM+dj tkus dh otg Reasons for leaving the job 12. D;k vkidks dhkh fxj rkj fd;k x;k gs] utjcanh fd;k x;k gs ;k fdlh vijk/k ds fy, vkidks fdlh U;k;ky; }kjk izfrcaf/kr fd;k x;k gs@tqekzuk yxk;k x;k gs@ltk nh xbz gs vfkok la?k yksd lsok vk;ksx }kjk ijh{kk esa Hkkx ysus ij jksd yxkbz gs\ ;k vkidks fo ofo ky;@ izkf/kdj.k@lalfkk ls izfrcaf/kr@fdlh Hkh ijh{kk es a csbus ls oftzr@fu"dkflr fd;k x;k gks\ vxj mrrj ^gkwa* gs] rks dsl dk iwjk C;kSjk] tqekzuk] nks k flf)] n.mkns k vkfn dk myys[k djsaa Have you ever been arrested or kept under detention or bound down / fined / convicted by a Court of Law for any offence or debarred / disqualified/restricted by the Public Service Commission from appearing at its examination selections or debarred from taking any examination or restricted by University/authority / institution? If answer is YES full particulars of the case detention, fine, conviction, sentence etc., should be given. 13- D;k bl vuqizek.ku QkeZ dks Hkjrs le; fdlh Hkh U;k;ky; fo'ofo ky; ;k fdlh Hkh 'ks{kf.kd izkf/kdj.k@lalfkk esa vkids fo:) dksbz ekeyk yfecr gs ;fn ¼d½ vfkok ¼[k½ esa iwns x;s iz'uksa ds laca/k esa vkids mùkj gk esa gks rks vkidks bl vuqizek.ku QkeZ Hkjrs le; ekeys] fxj rkjh] fujks/k tqekzus] nks"kfl) rfkk n.mkns'k vkfn ds iwjs C;kSjs izlrqr djus pkfg,a rkfd bl QkeZ dks Hkjrs le; U;k;ky;@fo'ofo ky;@'ks{kf.kd izkf/kdj.k vkfn ds le{k tks ekeyk yfecr gks mldk Lo:i crykuk pkfg, bl tkudkjh ds vfrfjdr tgka ykxw gks ogka fueufyf[kr C;kSjs Hkh fn;s tk;sxsa%& Øekad en 1 vijk/k@vkjksi 2 iqfyl Fkkus es a iathc) 3 ;fn U;k;ky; esa pkyku izlrqr fd;k x;k gks rks U;k;ky; dk uke 4 ekeys dk Ø-@U;k;k- }kjk mldk fuivkjk fdl frffk dks fd;k x;k 5 fn;k x;k n.m 6 D;k nks"keqdr dj fn;k x;k\ ugha ¼;fn gk ] rks fooj.k Hkh nsa½.. 4

19 (4) F-10 7 nks"keqfdr lansg ds ykhk ij vk/kkfjr Fkh ;k ekeyk okil ys fy;k x;k Fkk\ 8 D;k fdlh,sls laxze ;k laxbu tks ljdkj }kjk fof/k fo:)?kksf"kr fd;k x;k Fkk vfkok fd;k x;k gs] ds lnl; gs ;k mlds lg;ksxh jgs gsa\ ;fn,slk gks rks iw.kz fof'kf"v;ka nsa] tsls laxze@laxbu dk uke lnl;rk vfkok lec)rk dh dk;zokgh vof/k br;kfna ;fn bl QkeZ dks Hkjus vksj Hkstus ds ckn meehnokj dks utjcan ;k fxj rkj fd;k tkrk gs vfkok ml ij eqdnek pyk;k tkrk gs ;k mls canh cuk;k tkrk gs rks vfkok ml ij tqekzuk fd;k tkuk ;k mls nks"k fla) ik;k tkrk vfkok mls fooftzr fd;k tkrk gs ;k nks"keqdr fd;k tkrk gs rks C;kSjs ;FkkfLFkfr] jkt; yksd lsok vk;ksx ;k ml izkf/kdkjh dks ftls vuqizek.ku QkeZ igys Hkstk x;k gks] rrdky lwfpr fd;s tkus pkfg;s vfkok ;g ekuk tk,xk fd rf;kred tkudkjh fnikbz xbz gs] vr% ;g Lo;a meehnokj ds fgr esa gksxk fd og mu ekeyksa ds iwjs C;kSjs izlrqr djsa] ftues a mls fxj rkj fd;k x;k Fkk] ml ij vfhk;kstu pyk;k x;k Fkk] vkfn Hkys gh ekeys es a vfure :i ls izfrosfnr dj fn, gks ¼[kkRek½ okil ys fy, gks ;k mues a vurr% nks"keqfdr gks xbz ;k le>ksrk dj fy;k x;k gksa ;fn rf; fd vuqizek.ku QkeZ esa vlr; tkudkjh nh xbz gs ;k ;g fd dksbz rf;kred tkudkjh fnikbz xbz gs] fdlh O;fDr dh lsok ds nksjku fdlh Hkh le; /;ku esa vk, rks] mldh lsok,a lekir dh tk ldsaxha DECLARATION esa] izekf.kr djrk@djrh gwwa] fd iwokszdr lwpuk esjh lokszre tkudkjh vksj fo okl ds vuqlkj lgh vksj iw.kz gsa esa,slh fdlh ifjflfkfr ls ifjfpr ugha gwa] tks eq>s csad es a jkstxkj gsrq esjh ;ksx;rk dks {kfr igqapk ldrh gsa esjs vkosnu i= es a esjs }kjk fn;s x, dfku ds laca/k es a iqfyl tkap im+rky lfgr csad }kjk dksbz Hkh tkap dhkh Hkh fdlh Hkh le; ¼rqjar@fudV Hkfo ; esa½ ij djus esa eq>s Hkh vkifrr ugha gsa I certify that the foregoing information is correct and complete to the best of my knowledge and belief. I am not aware of any circumstance which might impair my fitness for employment in the Bank. I have / will have no objection to the Bank making enquiries at any time (immediately / in the near future) regarding the statement made by me in the application. In any manner they decide to do so inclusive of police enquire into my antecedents. Date : : meehnokj ds glrk{kj Signature of Candidate

20 EXPERIENCE CERTIFICATE (To be issued on letter head) This is certify that Mr/Mrs/Miss...S/D/W/O... is/was employee of Our Bank/Organization. He/ She was appointed in Officer Cadre/.. and working/worked as... (Designation) in our Bank/ Organization since... to.../till date. Adverse report/ D.E. pending or contemplated (If any) belongs to Mr./Mrs./ Miss...are as under : Seal and Signature of Appointing Authority Full Name: Designation: Name of Bank/Organization: ID: Tel. No. : Place: Date:

21 CHARACTER AND ANTECEDENTS VERIFICATION REPORT (APPLICATION FORM) To The Superintendent of Police, District Police Office, Subject : Application for Employee Verification Sir, It is requested that I have been selected as...in Baroda Rajasthan Kshetriya Gramin Bank, a Bank constituted under the RRB Act, 1976 and having its Head Office at Plot No. 2343, IInd Floor, Vaishali Nagar, Ajmer The Bank requires that my character and antecedents may be verified and a Police Verification Report may be issued to me. My personal particulars are as follow:- 1. Full Name (Expanded Initials) :... Alias (if any) : Father (Full Name) : Spouse (Full Name), if married : Occupation: Nationality :...Age...Sex...Caste Mobile No Permanent Address:- H.No....Sector/Village/Locality... Police Station...District... State...Pincode Proof of Identity (Voter Card/Driving Licence/Ration Card etc.) 9. Local (Current Address) : Residing at current address since : Particulars of Previous Employment, If any Nature of Employment... Address : Particulars of Previous Employer Particulars of relatives residing locally (Current) Local Address S.No. Name Father's Name Occupation Local Address (1) (2) (3) Photo (Self signed) (For use of S.P. Office) Name of the Applicant :... Father/Husband's Name :... Address : (Signature of Applicant) Photo (Attested by issuing Authority) Report : (Signature of the issuing Authority) Official Seal