GOVERNMENT OF MAHARASHTRA

ffiflrtrq ffih
GOVERNMENT OF MAHARASHTRA
DIRECTORATE OF INDUSTRIES
II floor, New Administrative Building,
Opp. Mantralay4 Hutatma Rajguru Chowh
Madam Kama Road, Mumbai-400 032.
APPLICATION FOR THE POST OF II\TDUSTRIES INSPECTOR
(LOWER GRADE) / EXTENSTON OFFTCER (TNDUSTRTES)
Important Instructions:
L Please read instructions in the advertisement carefully before filling up the application form.
2. The following information is to be filled in neatly by the applicant only in English CAPITAL
LETTERS with dark black ball point pen.
3. The applicant should affix his same photographs on the application
and the admission card of the examination which is at the end of the
application form.
4. Additional instructions given at the end of the application should be
carefully observed.
Affix Self
Attested Latest
Photograph
1. Full Name in Capital Leffers (As recorded in SSC Certificate)
SURNAME
FIRST NAME
2. Full Name in Case of Married Female Candidate
FATHER'S NAME
SURNAME
FIRST NAME
3. Complete postal address of the candidate in Capital Leffers
HUSBAND's NAME
City
State
Contact No.
Email Id:
District
Pin
Mobile No.
4. Date of Birth (As in SSC or equivalent Certificate) (DDA4M/YYYY format)
5. Age as on prescribed date in the advertisement (YY/MM/DD)
6. Gender: Male / Female

7 .l Category (Tick { whichever is applicable)
Unreserved SC ST Dr(A) Nr(B) SBC Nr(c) Nr(D) OBC
7.2 If Candidate belongs to backward class, mention caste /
community
7.3 If female, mention caste lcommunity by birth
8. If claiming reservation as female, physically challenged, ex-serviceman or meritorious
sports person (Tick { whichever is applicable)
Physically
Challenged
Female Ex-serviceman Meritorious Sports
Person
g.l If physically challenged (Tick { whichever is applicable)
Blind
Partially
sighted
Others
Low Vision
Partially
Deaf
One Arm
Affected
Both Legs
Affected
One Leg
Affected
Both Arms
Affected
Both Arms &
Legs Affected
Total Deaf
9.2 Percentage of Disability:
40 % or more than 40o/o I Less than 40%
9.3 Nature of Disability:
Permanent I Temporary
10.1 Amount of Fees Paid
Rs.2 501- I Rs .1501- | Nil
10.2 Demand Draft No Date
Name of the Bank
I I . If meritorious sports person, Furnish details of representation in
(Tick { whichever is applicable)
International
Competition
National
Competition
NCC
Performance
State School team in
National Games
Other
12. Do you belong to non-creamy layer
Yes / No
13. If Ex-Serviceman Total Number of years of Qualiffing Service
in the Armed Forces as on closing date: (YYA4M/DD)
14. Domiciled in Maharashtra Yes / No
15. Do you possess adequate knowledge to read write and speak Marathi Language
Yes / No

16. Whether liable to be disqualified for the Government Services according to the
provision of Maharashtra Civil Services (declaration of small family) Rules, 2005
Yes /No
17. Whether any proceedings in respect of departmental enquires or any disciplinary
actions are proposed or being conducted by Government, its PSUs, employer or bar
council
Yes / No
18. Whether any criminal proceedings are being conducted by Court of Law
I 9. Educational Qualification:
Yes / No
Sr.
No.
I
Name of
Examination
S.S.C.
Name of
University/
Institute/ Board
Date of
passing
Subject of
Specialization
Yo of
Marks
Grade /
Class
2 H.S.C.
3 Diploma
4 Degree
5 Masters
Degree
6 Any other
relevant
qualification
20. Details of experience (if Any):
I
2
Sr.No.
Name of Organization I
Employer
Post Held From To
3
21. Extra curricular activities, hobbies, etc.
22. Additional qualification
23. Computer literacy
24. Additional information

)
2)
Declaration
I hereby declare that all the statements made in this apprication are ffue, complete and
correct to the best of my knowledge and belief. In the event of any information being
found false or incorrect or ineligibility being detected before or after the examination
or selection, appropriate action can be taken against me by the recruiting authority, as
deemed fit.
I further affirm that I fulfill alt the conditions of erigibility regarding age limits,
Educational qualification' concession, etc. prescribed for admission to the examination.
Place:
Date :
Signature of Applicant
(Name of the Applicant)
NB:
1' The application should be submitted in_an envelope on which ..Application for the
POSt Of IIIDUSTRIES INSPECTOR (tOWirN CNNNN) / EXTENSION
^ QFF'ICER (II\DUSTRIES)', is written on its top.
2' The application should be addressed to the General Manager,
centre District
of the
Indushies
district in which the applicant resides (postal
application).
address in the
3
' A set of attested documents for establishing eligibility of the applicant as per the
. eligibility criteria shail be encrosed wirh the;ppr[uti*. -^
4. Demand draft of appropriate apprication fee shourd be encrosed with the
application.
5. Directorate of Industries shalr not be responsibre for non-receipt of any
communication due to incomprete/incorrect udd."rr. Apprication incomprete in
any respect shall stand rejected.
6. check List of documents to be submitted (point No. 3 above) arong with
application:
6. L S.S.C / Birthcertificate
6.2. H.S.C. certificate and mark sheet
6.3. Diploma certificate and mark sheet
6.4. Degree certificate and mark sheet
6.5. Domicile certificate from competent authority.
6'6' social category (caste certificate) certificate from competent authority. (If
candidate is fails to submit this ceriificate alongwi;i A" application form the
candidate will be considered as an open candidale.)
6'7' Non-creamy rayer certificate in cise of o.B.c, s.B.c, D.T.(A), N.T.(B),
N.T.(c) and N.T.(D) candidates. (If candidate i, roil. to submit category
certificate along with the application form the candidate will be considered as
an open candidate.)
6.8. certificate from.competent authority in case of physicaily challenged, Ex_
- servicemen, Meritorious sports person, etc.
9..-CopV of gazette inrespect:of change in name, if any.
6.10. NOC from employir for Goveriment employee.

q€r$g ';rrrii den q.1q,fl-{ {s qril gf$rarqq} f+ryq Qoor,. qrrrr ,rf-rTfT*ffi
'n"spt uturqT"Tr
.$qwff trftivlrrlt- n ;,iE.{r
H{.rtrfrq'{ qtT.{I-.3d
afwrrir :T6r]
S -d. r' ef|lirilr girrrr:i
81...,.
.,qtTt,.,qivfi tlt.rat,irf+nfl,r,f,i*,
qft* ,ilr . .
Tffiri *iE q
. .
, . . lt*Tl
t{,tnfr$fi} dfr,
TdrW nr,:r,,rslr
{.
r* - .
+ilq{ n-it} rfiqt
'
. qr r{rfifi*,f|.qwr xttWtqr ,sTr*.
\ . r e (iit,*'} $rpc iyErr
r*} ;a}r, nntml R.t

Directorate of Industries, Government of Maharashtra, Mumbai
Recruitment of Industries Inspector (LG) / Efrension Officer Qndustries)
DUPLICATE ADMIT CARD FOR WRITTEN EXAMINATION
NB:
l. Applicant must carry and show this Admission Card on demand
or else applicant shall not be allowed to take examination.
2. Applicant should be present in his seat in the examination hall l5
minutes before the scheduled time of examination.
3. Books, any material relevant to the syllabus / question paper in
any form and mobile/cell phones are prohibited in the
examination hall.
Affix attested
latest
photograph
1. Name of the Applicant:
2. Examination Seat No.:
3. Details of the examination centre:
Shri.Avfiss/Smt.
4. Date and time of the examination: / /2013. 1100 hrs to 1300 hrs
5. Signature of the applicant:
Place:
General Manager
District Industries Centre.
Date:
Note: Candidate shall bring Identity proof (Pan card/ Driving License/ Election Card/
:::::::::: :::l:: :i:::: :::: .#::*
Name of the Examination for which applying
Candidate's Full name and mailing address:
To,
Shri./Smt./Ku.......
PIN

Directorate of rndustries, Government of Maharashtra, Mumbai
Recruitment of Industries Inspector (LG) / Ertension officer (ndustrieg
ORIGINAL ADMIT CARD FOR WRITTEN EXAMINATION
NB:
l. Applicant must carry and show this Admission Card on demand
or else applicant shall not be allowed to take examination.
2. Applicant should be present in his seat in the examination hall l5
minutes before the scheduled time of examination.
3- Books, any material relevant to the syllabus / question paper in
any form and mobilelcell phones are prohibited in the
examination hall.
Affix attested
latest
photograph
l. Name of the Applicant:
2. Examination Seat No.:
3. Details of the examination centre:
Shri.AyIiss/Smt.
4. Date and time of the examination:
/ /2013. 1l:00 hrs to 13:00 hrs
5. Signature of the applicant:
PIace:
General Manager
Dishict Industries Centre.
Date:
Note: Candidate shall bring Identity proof (Pan card/ Driving License/ Election Card/
:::::::1_:i:::11:::::::::::::::_"":::::l
Name of the Examination for which apptying
Candidate's FulI name and mailing address:
To,
Shri./Smt.A(u
PIN