8/9/2019 2639641328applicationfomhyd

1/3

SOFTWARE TECHNOLOGY PARKS OF INDIA

(An autonomous Society under Department of Information Technology, Govt. of India)

APPLICATION FORM

Advt. No.STPH/01/2010

1. Please fill the application with Candidates ownhand writing and in CAPITALS only

2. One extra photograph of the candidate to be sentalong with the application

Details of Demand Draft/IPO :

(Please write your name & Post Code on reverse of the Demand Draft)

DD/IPO No._______________ Date: ______________ Amount (Rs.)________________

Bank/Post Office : ________________________________________________________

Post Applied for ________________________________________________________

1. Name __________________________________Surname ____________________2. Fathers Name __________________________________________3. Date of birth (DD/MM/YY) ____________________

In Words _____________________________________________________________

4. Do you belong to SC/ST/OBC/EXS/PH Category Yes / No(If yes, please give details)

5. Address for Correspondence 6. Permanent Address _____________________________ _____________________

_____________________________ _____________________

_____________________________ _____________________

Contact Tele Numbers Contact Tele Numbers

(O) ____________________ (O) ____________________

(R) ______________________ (R) ____________________

Email ID : ______________________________

Please affix passport

size Photograph duly

signed

8/9/2019 2639641328applicationfomhyd

2/3

7. Educational Qualification (Start from S.S.C.). Enclose copies of certificatesSl.

No.

Exam Passed University/ Board Year of

passing

Subjects

Passed

% of marks

& Division

No. of

attempts

8. Past/Present Experience (start from Present) Enclose copies of certificatesPeriodName of the

employer with

address

Please indicate

whether Govt/

Semi Govt./Public

Undertaking/

Private

Designation,

Pay Scale &

Salary

From To

Nature of Duties &

Responsibilities

9. Language in which test/interview preferred : Hindi / English10.a) Have you applied any other post against this advertisement : Yes/No

b) If Yes, details of the post applied

8/9/2019 2639641328applicationfomhyd

3/3

11.Any other information, the candidate may like to add

12.Declaration:I do 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 and agree that in theevent of any information being found false or incorrect/incomplete or ineligibility

being detected at any time before or after selection/Interview, my candidature is liable

to be rejected, I shall be bound by the decision of the Director, STPI, Hyderabad.

Place:

Date:

Signature

Part II

(To be filled in by the Competent Authority in the case of candidates who are presentlyworking in Government / PSUs / Autonomous Organizations only)

Certified that :-

(i) The information given below by the officer is correct.(ii) No vigilance / disciplinary proceedings are either pending or contemplated

against the above mentioned officer.

Signature : _____________________

Name : _____________________

Designation : _____________________

Date: ________________________ Department : _____________________