DISTRICT LEVEL SELECTION COMMITTEE, COOCH BEHAR
Recruitment to various posts at Gram Panchayat and Panchayat Samiti Level
in Cooch Behar district
Application Form

To,
The District Magistrate & Chairman
District Level Selection Committee,
Cooch Behar


Application for the post of *
 
    Please Enter Name*
Name of the Applicant (in Block letters)*     Please Enter Name*
Father's/Husband's Name*
Category *
Select Sport *
Address
Village/Street *
P.O.:     Please Enter P.O.*
Block/ Municipality*:     Please Enter Block/ Municipality**
P.S. * (mimimum 3 chars)     Please Enter Name*
State *     Please Enter Name*
District *
    Please Enter Name*
Pin Code:     Please Enter Name*
Mobile No.* (only 10 digit number)
Date of Birth*     Please Enter Name*
Age as on 01/01/2016 *     Please Enter Name*
Gender*
   
Educational Qualification: *(Mention from Xth Std. and upwards)
Select Option Board/University/ Institute
Examination Passed Year of Pass Total Marks Marks Obtained
(Keep blank if
marks not available
in grade card)
CGPA/ % (e.g. 99.0) /
Grade
Xth or equiv.
XII or equiv.
Graduation
Post Graduate
B.Ed
B.E.(Civ.)/ B.Tech(Civ.)/ Diploma in Civil Eng.
Diploma in Computer
B.Tech(IT)/ BSc.(Comp. Sc.)/ BCA or equiv./ MCA/M.Tech.(CSc.) or equiv.
DOEACC 'A' /'B'/ 'C' Level
Post Graduate Degree/ Diploma in Social Work or Rural Development

Institute Name (with Cert. No., Date and issuing Authority)):
  Year of Passing
  
Experience in Social Work/ Rural Development Details of experience (with Cert. No. & Date and issuing Authority):

  
Details of other Experience (if any)/ Computer knowledge * (write NIL for no experience)
   
(*) - Star marked fields are essentially to be filled by the candidate.