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VISAKHAPATNAM STEEL PLANT

Recruitment Advt. No.07/2012(Please fill in English only)

Application for the Post of _______________________________

(Chief Specialist/Dy Chief Specialist Cardiology / Neuro Surgery /Plastic Surgery)Specialist / Junior Specialist - General Medicine/Anesthesia

Deputy Manager / Assistant Manager Horticulture)

I. Personal Details

1. Name (Surname first)(IN BLOCK LETTERS)

2. Fathers Name

3. Contact Address

PIN

4. Telephone No. with STD code

Mobile No. (mandatory)

E-Mail ID (mandatory)

5. Date of Birth (Please encloseproof)

DD ________ MM ___________ YYYY ___________

6. Gender (Male/Female)

7. Religion

8. Category [Gen/OBC(noncreamy layer)/SC/ST)

II Educational Qualification (from Graduation onwards)(Please enclose certificate copies)

Course nameBoard / University/

InstituteSpecialization

Duration(MM/YY)

%ageof

Marks

Grade/Class

From To

Affix your latestpassport sizephotograph

(Colour) and signon it (do not pin or

staple)

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III Employment details* (beginning with the latest)

(Please enclose experience certificate copies)

Total post-qualification experience: _________ years __________ months

Organization, Designation withScale of Pay/ Emoluments

Period (mm / yy)Responsibilities

From To

On selection, how soon can youjoin?

Any other information

NOTE: * Please attach separate sheet(s) if space given is insufficient.Please attach copy of State Medical Council Registration No. and Date

_____________________________________________________________________________________________

IV. Details of Challan (for General / OBC candidates)

Deposit Journal No.:_____________________ Date of deposit:________________________

SBI Branch Code_______________________ Amount:`300/-

(Please enclose VSP copy of challan)

DECLARATION:I hereby declare that I agree with all the terms & conditions given in the aforesaid advertisementand that all the information stated in this application form are true. In case any of my declarationand documents attached herewith is found to be untrue and if I am unable to produce relevantdocuments in support of the eligibility condition, my candidature may be cancelled at any stage

of the recruitment process. In the event that the wrong statement is detected after myappointment then my services are liable to be terminated without notice.

Place: _______________________ _______________________Signature of the candidate

Date: _______________________

Application complete in all respects with self attested copies of certificates / testimonials shouldbe sent by speed post / courier to Sr. Manager(Personnel)-Recruitment, Room No.232,Main Administrative Building, Visakhapatnam Steel Plant, Visakhapatnam-530 031so asto reach latest by 30thJuly 2012.