[Adv.No. - 01/2025] Technician 'A' (Electronics)(UR) at Science Centre, Burdwan Step 1 of 2 50% 1) Name* First Middle Last *Middle name is not mandatory2) Gender* Male Female Transgender 3) Upload your recent colour photo* Photo must be 300 pixels (width), 400 pixels (height) and less than 100KB in size. The photo must be in jpeg or jpg format. Note: Ensure through preview that photo appears in full. Click here for photo upload guide 4) Upload scanned image of your signature* Signature must be 300 pixels (width), 100 pixels (height) and less than 100KB in size. The image must be in jpeg or jpg format. Note: Ensure through preview that signature appears in full Click here for Signature upload guide5) Present Address* Street Address Address Line 2 City/ District State / Province / Region ZIP / Postal Code India Country 6) Permanent Address* Same as present address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code India Country 7) Date of Birth* DD slash MM slash YYYY dd/mm/yyyy8) Place of birth*9) Are you a citizen of India by birth and/or by domicile ?* Yes No 10) Are you a person having migrated from Pakistan/ Bangladesh/ other countries with the intention of permanently settling in India? or subject of Nepal/ Sikkim?* Yes No 11) Father’s name*12) Father’s Occupation*13) Father’s address*14) Mother’s name*15) Mother’s Occupation*16) Mother’s address*17) Is or was your father/mother a citizen of India by birth and/or by domicile?* Yes No 18) Is or was your father/mother a person having migrated from Pakistan or Bangladesh or other countries with the intention of permanently settling in India or a subject of Nepal?* Yes No 19) Total income of the family per month*20) State your religion*21) Caste/ Category?* General EWS OBC SC ST 22) Are you physically challenged ?* Yes No 23) Are you a widow, divorced woman and judicially separated?* Yes No 24) Are you an Ex-Serviceman?* Yes No No. of years servedPension payment order no./ PRAN No.ECHS card no.PAN/AADHAAR no. if any.25) Particulars of all examinations passed and degrees and technical qualifications obtained at the university or other places of higher technical education (commencing with the Matriculation or its equivalent examination).*Examination PassedName of the Board/Institute/ University% of Marks obtainedDivision/ Class obtainedYear of passingSubjects taken For ITI or equivalent exam, please mention the specific Trade (viz. Electronics/Electrical/Carpentry/Fitting/Machinist/Painting/Sheet Metal/Draughtsmanship/ R & AC) under the column Subject taken26) Duration of ITI or equivalent course (in year)*1 year2 year27) Total experience after ITI or equivalent (in years)*28) What language (including Indian language) you can read, write or speak. Give particulars and state any examinations passed in each.*Read onlySpeak onlyRead and speakRead, write and speakExamination passed, if any EnglishHindiBengaliEnglishHindiBengaliEnglishHindiBengaliEnglishHindiBengali EnglishHindiBengaliEnglishHindiBengaliEnglishHindiBengaliEnglishHindiBengali EnglishHindiBengaliEnglishHindiBengaliEnglishHindiBengaliEnglishHindiBengali click on (+) for adding more rows.29) Experience (give details of all employment)*Name of OrganisationDate of joiningDate of leaving and reasons thereforDesignation and Nature of workSalary and Grade click on (+) for adding more rows.30) Are you presently employed in Government / Semi Government / Autonomous organisation ?* Yes No Number of years in continuous service*Declaration I declare that I have intimated in advance to my present employer and I will submit no objection certificate from my present employer at the time of appearing in written examination / skill test. 31) If selected what notice would you require before joining?* Immediate One month Two months Three months 32) Have you any relative working in the NCSM?* Yes No Provide details:*33) Are you willing to work anywhere in India?* Yes No Note : 1. Information in respect of Columns 7, 21, 22, 23, 24, 25, 29 should be supported by self attested copies of certificates and testimonials, otherwise, the application will not be considered. 2. Canvassing in any form and/or bringing in any influence political or otherwise will be treated as a disqualification for the post. Upload Document Proof of Date of Birth* Drop files here or Select files Accepted file types: jpg, jpeg, Max. file size: 1 MB, Max. files: 1. Upload the birth certificate or secondary admit card. File type must be jpg, jpeg maximum of 200KB in sizeUpload Caste/ EWS Certificate.* Drop files here or Select files Accepted file types: jpg, jpeg, Max. file size: 1 MB, Max. files: 1. File type must be jpg, jpeg maximum of 200KB in sizeUpload Certificate for physically challenged.* Drop files here or Select files Accepted file types: jpg, jpeg, Max. file size: 1 MB, Max. files: 1. File type must be jpg, jpeg maximum of 200KB in sizeUpload Pension Payment Order (PPO).* Drop files here or Select files Accepted file types: jpg, jpeg, Max. file size: 1 MB, Max. files: 1. Upload Pension Payment Order (PPO). File type must be jpg, jpeg maximum of 200KB in sizeUpload Marksheet of Secondary exam.* Drop files here or Select files Accepted file types: jpg, jpeg, Max. file size: 1 MB, Max. files: 1. File type must be jpg, jpeg maximum of 200KB in sizeUpload Marksheet of ITI or Equivalent exam.* Drop files here or Select files Accepted file types: jpg, jpeg, Max. file size: 1 MB, Max. files: 1. File type must be jpg, jpeg maximum of 200KB in sizeUpload experience certificate.* Drop files here or Select files Accepted file types: jpg, jpeg, Max. file size: 1 MB, Max. files: 5. File type must be jpg, jpeg maximum of 200KB in size. You can upload a maximum of 5 nos. files for experience certificate.Upload death certificate of the spouse/ documents of judicial separation or divorce order of the appropriate authority.* Drop files here or Select files Accepted file types: jpg, jpeg, Max. file size: 1 MB, Max. files: 1. File type must be jpg, jpeg maximum of 200KB in sizeDeclaration* I hereby declare that the information furnished in this application is true & correct to the best of my knowledge and belief. Mobile No.*Email* Enter Email Confirm Email Answer the follow security question? (enter answer in number)ten plus five = CAPTCHA {all_fields}This field is hidden when viewing the formpayment linkOn submission you will get a payment link / email id verification link in your registered email. If you do not receive the email in your inbox, please check your Spam/ Junk folder.