Application Format - Syndicate Bank

APPLICATION FOR THE POST OF ………………………………………………….
To:
SYNDICATE BANK SPEICALIST OFFICERS' RECRUITMENT PROJECT - 2012
POST BOX NO. 64
MANIPAL - 576 104.
UDUPI DISTRICT, KARNATAKA
In response to your advertisement in the Website dated _______________________________, I
submit my Application in the prescribed format.
1. FULL NAME IN BLOCK LETTERS: (Leave one space blank between two parts of your name)
Mr./Ms. :
2. ADDRESS FOR CORRESPONDENCE:
* P O S T O F F I C E
* P I N C O D E
* D I S T R I C T
* S T A T E
* Mandatory fields and should invariably be filled up.
3. POST APPLIED FOR : ___________________________ CODE :
4. (i) CATEGORY TO WHICH YOU BELONG :
Write SC/ST/OBC/GEN in the box as applicable
(Please enclose photocopy of certificate in case of SC/ST/OBC) (OBC Certificate should be in
the prescribed format meant for Central Government posts and should have been issued on or
after 01.04.2011).
ii) IN CASE OF PERSONS WITH DISABILITY :
Write OC/VI/HI in the column as applicable
Please write percentage of disability (Please enclose photocopy of certificate) .
5. DATE OF BIRTH: DD MM YYYY
AGE (As on 01.11.2011): ___________ Years
PLEASE AFFIX
YOUR RECENT
PASSPORT SIZE
PHOTOGRAPH
AND
SIGN ACROSS
Relaxation in Age (if claimed) : No. of Years Under category : __________
[Please refer to advertisement as regards your eligibility for claiming relaxation in Age]

PARTICULARS OF FEE PAID: Application Fee may be paid at any of the Branches of
Syndicate Bank free of charges, by means of a Payment Challan
Name of the Branch BIC Date of payment
Transaction ID/
Scroll No
Copy of the Payment Challan should be enclosed to the application.
Amount (`.)
Demand Draft,Cheques, Money Orders, Pay Orders, Banker’s Cheques, Postal Orders,
Postal Stamps will NOT BE ACCEPTED.
6. YOUR CONTACT NO.:
STD Code No. Telephone No. Mobile No.
E- Mail Address
7. INDICATE BY MARK IN APPROPRIATE BOX:
(i) GENDER : MALE FEMALE
(ii) Whether employed: YES/NO
If employed:
Name of the Employer
Full Address of the Employer
(iii): MARITAL STATUS:
SINGLE MARRIED WIDOW/WIDOWER DIVORCEE
(iv) a] Are you an Ex-Serviceman ? : YES NO
b] In case of Ex-serviceman, specify
1. No. of years of service :
2. Date of Discharge : ______________
3. Rank at present/last held A) Acting ______________ w.e.f. ________
B) Substantive ______________ w.e.f. ________
(v) Are you a candidate who was domiciled in Kashmir YES NO
Division of State of Jammu & Kashmir during the
period 01.01.1980 to 31.12.1989.
(vi) Whether you belong to Religious Minority Community ? YES NO
If Yes, indicate by in the appropriate box :
In case of SC/ST/OBC Candidate
(i) Name of the Caste/Tribe/Community : __________
(ii) Name of the state to which you belong ____________
Christian Muslim Budhist Sikh Zorastrian

8. FATHER’S NAME:
9. HUSBAND’S NAME (in the case of married women):
10. Whether Spouse is employed (in the case of those married) ? YES NO
If yes, Name of the Employer :
Post held :
Nature of duties :
11. NATIONALITY ___________________ RELIGION ____________________
12. PLACE OF BIRTH : Place _________________ Dist. ______________State __________
13. PERMANENT ADDRESS:
* P O S T O F F I C E
* P I N C O D E
* D I S T R I C T
* S T A T E
*Mandatory fields
14. HOME TOWN/VILLAGE : _________________ DISTRICT: _________________ STATE: ___________
15. Are you suffering from any major Health problems? YES NO
If yes, give details
16. EDUCATIONAL / PROFESSIONAL QUALIFICATIONS:
(from 10 th Standard onwards as on 01.11.2011)
A) Details of all Examinations passed on or before 01.11.2011. If all the information in the
box is not provided the application will be rejected.
Note: Percentage of marks secured in aggregate shall be rounded off to nearest 2 decimals.
Particulars
X Standard
XII Standard
Graduation
Post Graduation
Name of
the Degree
Name of Board/
University
Core Subjects other
than
languages studied
Class/
Division
Date/Month/
Year of
passing
% of
Marks

17 Level of Computer Literacy (Indicate by mark in appropriate column)
Certificate Course in Windows, MS
word from a recognized Institute
As a subject in Degree /PG level
18 PARTICULARS OF POST-QUALIFICATION EXPERIENCE (As on 01.11.2011) [Enclose
Certificate of experience]
Name of Employer &
Nature of activities
carried out by them
Period of service
Designation
Length of
Service
From To Years months
(If space is not sufficient please attach separate sheet)
Nature of
duties
performed
Remarks
(Reason for
leaving service)
19. Languages known : (Indicate by mark in appropriate box) (Mention the names of
languages known in the appropriate column)
Sl. No. Language Read Write Speak
1
2
3
4
BEFORE MAILING APPLICATION, PLEASE CHECK THAT YOU HAVE CORRECTLY:
1. Mentioned the Name of the Post and Post code you have applied for.
2. Enclosed certified copies of the following:
a) Caste/Tribe/Community/Disability/Defence Service Certificate in the case of candidates belonging to
SC/ST/ OBC/PH/XS.
b) SSLC/X Class Certificate/Marks Card containing Date of Birth .
c) Degree Certificate & Marks Card
d) Degree and/or Post Graduate Degree Marks Card
e) Computer qualification Certificate.
f) Certificate of experience
3. Mentioned the details Payment Challan enclosed.
4. Furnished the Address for correspondence.
5. Enclosed the relevant certificate(s) for claiming relaxation in age.
6. Ensure that no column in the application is left blank. If any column is not relevant, mention NA
DECLARATION
I 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 that in the event of any
information being found false or incorrect at any stage or not satisfying the eligibility criteria
according to the requirements of the relative advertisement, my candidature / appointment is
liable to be cancelled/terminated. I am willing to serve anywhere in India. I agree that Bank
has right to transfer me to any part of the country at its discretion.
I hereby agree that any legal proceedings in respect of any matter(s) or claims or disputes
arising out of this application and/or out of said advertisement can be instituted by me at
Courts/Tribunals/Forums at Udupi only shall have sole and exclusive jurisdiction to try any
cause/dispute. I undertake to abide by all the terms and conditions mentioned in the
advertisement given by the Bank.
Place :_____________ Date :__________ __________________
Signature of applicant