OFFICE OF THE PURULIA ZILLA PARISHAD , PURULIA

Recruitment to the post of District Coordinator, Assistant Coordinator(Tech),Data Entry Operator under Mission Nirmal Bangla Cell in Purulia Zilla Parishad, Purulia
Application Form
Application for the post of *
Name (in Block letters) * (minimum 4 chars)
Note 1: Name as recorded in the Matriculation/Secondary Examination Certificate.
Note 2: Please do not use any prefix such as Mr. or Sri. etc.
Father's Name * (minimum 4 chars.)
Note 1: Please do not use any prefix such as Mr. or Sri. or Late .
Mother's Name * (minimum 4 chars.)
Note 1: Please do not use any prefix such as Mrs. , Smt. or Late etc.
Address for Communication *
(mimimum 5 chars , Maximum 200 chars )
Note 1: Please do not use any of the following special charecters & ) ; ( and %.
P.O. * (mimimum 3 chars)
PIN Code * (only 6 digit number)
Gender *
Nationality *
Date of Birth*
[Date of Birth as recorded in the Matriculation/Secondary Examination Certificate]
Age as on 01/01/2019:
Mobile No.* (only 10 digit number)
E-Mail*

TABLE X - Educational Qualification: *
Exam Type Board/University/ Institute
Course Year of Pass Percentage Obtain(e.g. 99.0)
1.Madhyamik or Equiv
2. HS / 12th
3. Graduation
4. Post Graduation
Certificate Course in Computer

  Whether presently employed (if yes give particulars) Note 1: Please do not use any of the following special charecters & ) ; ( and %.
Experience Mandatory for District Coordinator
From : To :
Upload Scan Copy of Self Attested Proof of identity ( AADHAR / EPIC / DRIVING LICENSE ) (PDF or JPG Format,less than 200KB)
No Document uploaded
Upload Scan Copy of Self Attested Age proof (Birth Certificate / Certificate of Madhyamik or Equivalent) (PDF or JPG Format,less than 200KB) *
No Age proof Uploaded
Upload Scan Copy of Self Attested Xth Marksheet(PDF or JPG Format,less than 200KB)*
No Xth Marksheet uploaded
Upload Scan Copy of Self Attested XIIth or Equivalent Marksheet (PDF or JPG Format,less than 200KB)*
No XIIth or Equivalent Marksheet uploaded
Upload Scan Copy of Self Attested Graduation Certificate (PDF or JPG Format,less than 200KB)*
No Graduation Certificate uploaded
Upload Scan Self Attested Computer Training Certificate (PDF or JPG Format,less than 200KB)Mandatory for Data Entry Operator
No Computer Training Certificate uploaded
Upload Scan Copy of Self Attested Post Graduation /PGDCA / Diploma Certificate(PDF or JPG Format,less than 200KB)*
No Post Graduation Certificate uploaded
Upload Scan Copy of Self Attested Work Experiene Certificate (PDF or JPG Format,less than 200KB)Mandatory for District Coordinator
No Work Experience Certificate uploaded
Upload Scan Copy of Recent Color Photo (Dimension H X W : 120x100 JPG Format , less than 50KB) *
No Photo Uploaded
Upload Scan Copy of Signature (Dimension H X W : 75X200 JPG Format,less than 50KB) *
No Signature uploaded
Declaration *
   I solemnly declare that the statement made in this application are true and complete to the best of my knowledge and belief and in the event of any information being found false or incorrect my candidature will be liable to be cancelled. I have informed Head of my Office/Department in writing that I am applying such post (if applicable)
Security Code*   
(*) - Star marked fields are essentially to be filled by the candidate.
Validate Application before Submission