Annexure III "Application Form" - Karnataka, India

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Annexure-III
KSRSAC/17/KGIS/Advt/01/2017
APPLICATION FORM
======================================================
Sl. No. & Name of post Applied :
Domain Specialization (a candidate can apply for not more than 2 domains)
1.
2.
======================================================
Details of Applicant
1. Name
2. Gender
3. Mother’s/Father’s/Husband’s Name
4. Date of Birth ; Age
5. Marital Status
6. Address for Correspondence
7. Permanent Address
8. Languages Known
9. E-mail ID
10. Mobile No.
11. Details of Identification proof
(PAN No / Aadhar No / Passport No)
12. Educational Qualification
Sl.
Degree/
Specialization
Percentage /
University
No.
Certificate
Class & Year of
Passing
1
2
3
4
Page 1 of 3
Annexure-III
KSRSAC/17/KGIS/Advt/01/2017
APPLICATION FORM
======================================================
Sl. No. & Name of post Applied :
Domain Specialization (a candidate can apply for not more than 2 domains)
1.
2.
======================================================
Details of Applicant
1. Name
2. Gender
3. Mother’s/Father’s/Husband’s Name
4. Date of Birth ; Age
5. Marital Status
6. Address for Correspondence
7. Permanent Address
8. Languages Known
9. E-mail ID
10. Mobile No.
11. Details of Identification proof
(PAN No / Aadhar No / Passport No)
12. Educational Qualification
Sl.
Degree/
Specialization
Percentage /
University
No.
Certificate
Class & Year of
Passing
1
2
3
4
Page 1 of 3
(Chronological order, latest first)
13. Experience Details
Sl.
Organization
Position held
From- To
Duties
No.
Name
(year /
Performed
month)
1
2
3
14. Brief Summary on Domain Expertise / Skillset (relevant to the position applied)
15. Technical Skills* (add more skills, as / if needed) with rating for each
( 1-basic; 2 – Good working Knowledge; 3 – expert)
*delete whichever is not relevant. Any additional technical skills can be added under “others”
 Project Management tools
 Web Programming Languages :
 Mobile Programming language /platform
 Graphic / Web design tools or SW :
 Content Management software:
 Server / Network Management tools:
 Storage / Backup management tools:
 Data warehousing software:
 Data Analytics / MIS tools:
 GIS Server Packages :
 Image Processing Server Packages:
 Bigdata Processing and Analytics:
 Desktop CAD / GIS & IP Software:
 Software Testing tools
 Version and Configuration
management tools
 Web service development /
deployment
 Web Server technologies
 Operating System
 Other Technologies / tools :
Page 2 of 3
16. Specific project details / technical skills, in brief which candidate would like to
emphasize to substantiate the skillset in the relevant areas of domain expertise.
(Additional pages / annexure can be provided, if needed)
17. Membership in Professional Bodies
18. Certification / Trainings undergone
19. Achievements, if any
20. Current CTC:
21. Time Period to Join, once selected
22. Any Other relevant information in brief:
Note: Attach self-attested copies of documents regarding age, qualification and experience
along with photo ID.
Declaration
The information furnished above is true. I have carefully read the terms and conditions of
the engagement and they are acceptable to me. I certify that no disciplinary proceedings
are pending against me, as on date. I also certify that the qualifications/experience and
other details in my application are correct and authentic.
Place:
Date:
Signature of the Applicant
Name
Page 3 of 3
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