To : The General Manager CANARA BANK Recruitment Cell, Human Resources Wing, Head Office, 113/1, J C Road Bangalore - 560 002

Please affix your recent passport size photograph and sign it across.

E-mail : [email protected]

Sub : Application for the post of Chief Security Officer in SMG Scale-V [To be filled in by the candidate in his/her own handwriting. Please read the Advertisement carefully before filling up this form]

With reference to the above, I am submitting my application for CB/RP/1/2016-Chief Security Officer (SMGS–V). 1. 2

Full Name : [In capital letters] Correspondence Address: (in capital letters)

Permanent Address: (in capital letters)

PIN

PIN

Phone No. with STD code: __________________

Email: ___________________________________

Mobile No: ______________________________

Alternate Mobile No (if any)_________________

Date of Retirement from ARMY / NAVY / AIR FORCE /POLICE/PARA MILITARY FORCES : _______________ Rank last held : _________________________________ 3.

Date of Birth

DD

MM

AGE: (Max-55 yrs ) [As on 01.04.2016] (inclusive of all relaxations)

YYYY

[As per SSC/SSLC]

4.

Gender

MALE

5

FEMALE

(ARMY / NAVY / AIR FORCE / POLICE /PARA MILITARY FORCES)

Religion

6

Years

Nationality

Months

Days

Indian

7. Marital Status (Single / Married / Widowed/Divorced/Legally Separated) : 8.

Father’s Name Mother’s Name Spouse Name [In capital letters]

9. Category: SC

ST

OBC

Gen

(Tick Appropriate Box)

In case you belong to SC / ST / OBC, Name of Sub-Caste or Community Name : ______________________ In case you belong to SC / ST / OBC category, indicate the Serial number of Sub-caste as appearing in the Central Government list : _________________________ 10. In case of Persons with Disability (PWD), type of disability: HI / OC /VC 11. (a) (b) (c )

Percentage of Disability %:____

Native Place : _____________________ District_____________________ State _______________________ Mother Tongue _____________________ Languages Known Read Write Speak _______________ ____________ ______________ _______________ ____________ ______________ _______________ ____________ ______________ _______________ ____________ ______________

PAGE:2

\

12. Application Fees Details: Name of the Bank (remittance made)

Branch with Code [IFSC Code for other Banks]

Transaction ID / NEFT UTR No.

Amount Paid

`.

Payment Date

/-

Note: Original Payment Challan / NEFT receipt should be enclosed

13. Knowledge in Computers: Proficient:

Working Knowledge:

YES / NO

14. Knowledge in Hindi: YES / NO

Proficient:

YES/NO

Working Knowledge:

YES/NO

% of Marks

Class / Grade

15. Educational Qualification [As on 01.04.2016] : Examination Passed

Name of the University /Board

Month & year of passing

10th Std /SSC/SSLC 12th Std /PUC/HSC Graduation (BA/BSc/BCom etc.) PG if any Professional Others 16. Experience Details: Name and address of the Employer / Army / Navy / Air force / Police / Para Military Forces / Others

Designation / Post held / Rank

From Date

To Date

Duration of Service (Y/M/D)

Medals Won (if any)

Note: Self attested Photocopies of qualification & experience etc are to be enclosed

17

Particulars of participation in Sports, Athletics, Scouts, NCC, Debates, Dramas or other Extra-Curricular activities in School, College and elsewhere

:

18

Hobbies and other interests

:

19 a]

Have you ever been arrested, prosecuted, kept under detention or bound down / fined / convicted by a Court of Law or whether any case is pending against you in a Court of Law? If yes, give full details

:

Have you ever been debarred / disqualified by any institution from appearing at its examination / selection or debarred in any manner from any examination or rusticated by any University or any other educational authority / Institution ? If yes, give full details

:

b]

Reasons for Leaving

PAGE:3

c]

Is any case pending against you in any University or any other educational authority / Institution at the time of filling up this : form? If yes, give full details

d]

Has any case been filed against you at present or in the past by : any Bank, Insurance Company etc., for non-payment of any loan taken from them? If so, please give details

20 a]

In case you are / were an employee of the Government/ Public Sector / Nationalized Bank/ Municipal Corpn./ Private Sector : Organization, please state whether there is any disciplinary case pending against you or whether any disciplinary case was taken against you during the last 3 years of your service. If so, please give details

b]

Were you ever removed/dismissed/made to resign from such service in the past? If so, please give details.

:

21. Documents/Certificates Submitted along with this application (Xerox copies) : (tick the appropriate box)

Copy of Payment Challan Birth Certificate / SSC / 10th/SSLC certificate with DOB Copies of the mark sheets & certificates of SSC/SSLC/X STD, PUC/10+2/ Intermediate, Graduation & other qualifications etc. Copy of Discharge Book (All pages) / Relieving order If candidate is still in defense service, a certificate from the competent authority which shows experience, rank last held etc. Copy of Caste Certificate in prescribed format (in case of SC / ST / OBC category candidates) Any other relevant documents (specify below) _______________________ 22. Any other Information candidate wish to furnish: (if required candidate can attach a separate sheet) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Declaration : I ______________________________________ hereby declare that I had read Canara Bank advertisement CB/RP/1/2016 published in Bank’s website fully & thoroughly and understood the contents and I undertake to abide by all the terms & conditions. Further, I certify that all the information furnished in this application are true and correct to the best of my knowledge and belief. I am aware that in case I have given a wrong information or suppressed any material fact or factual information or if I do not satisfy the eligibility criteria according to the advertisement, then my candidature will be rejected / services will be annulled even after permanent employment without giving any notice or reasons thereof. I am willing to serve anywhere in India depending upon the Bank’s requirement and shall abide by the Service & Conduct rules of the Bank applicable from time to time. I agree that any legal proceedings in respect of any matter or claims arising out of this application or out of the said advertisement can be instituted by me at Bengaluru only and the courts situated in Bengaluru only shall have sole and exclusive jurisdiction to try any cause / dispute.

Place: Date :

Signature of the Applicant

FOR OFFICE USE Application Processed / Scrutinized by: Name : Designation : Date:

Checked by: Name Designation Signature

Date :

: : Signature

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