Application Form

Kindly fill all the fields. Fields marked with * are mandatory.
Code of the Post * :

Basic Details

Name of the Candidate
First Name*:
Middle Name:
Last Name:

Date Of Birth*:
 
Gender*:
Date of retirement from Govt. service (Enclose copy of Identity Card issued for Pensioners)*:
 

Father's/Husband's Name
Relationship:
First Name*:
Middle Name:
Last Name:


Address :
Correspondence Address :
City :
State*:
Pincode (6 digit):
Permanent address same as above
Permanent Address*:
City :
State*:
Pincode (6 digit)*:

Contact Details :
Email Address*:
 
Mobile Number (10 digit)*:
Last Substantive Post held before retirement *:
Basic Pension (enclose copy of PPO/Last Salary Slip) :




Details Of Previous Experience

SNoMinistry /DepartmentPost heldPeriod FromPeriod ToBrief Description of Duties 
1     Delete
       

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Have you ever been assigned the responsibility of Inquiry Officer/Presenting Officer if Yes, the details thereof*
Details if any

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Whether retired on attaining the age of Superannuation or voluntary retirement
Enter Superannuation or Voluntary Date in Format(01 May 2021)* and Details if any

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Whether any penalty was imposed during the service. if yes, the details thereof*
Details if any

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Whether any disciplinary proceedings is still under way against you. if yes, the details thereof*
Details if any

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Whether any FIR/Criminal case ever registered against you. if yes, the details thereof*
Details if any

Documents Upload
Photograph
Scanned copy of photograph in only .jpg/.jpeg or .png or.gif image types not exceeding 1 MB.
 
Signature
Scanned copy of signature in only .jpg/.jpeg or .png or.gif image types not exceeding 1 MB.
 
Proof of Pension
(PPO or Last Pay Slip)
Scanned copy of PPO / If Basic Pension amount 0 then Last Pay Slip in only .jpg/.jpeg or .png or.gif image types not exceeding 1 MB.
 
Upload Identity Card
Scanned copy of Identity Card in only .jpg/.jpeg or .png or.gif image types not exceeding 1 MB.
   

Declaration

I have carefully gone through the vacancy advertisement and I solemnly declare and undertake that all the information furnished by me is true, correct and complete to the best of my knowledge and belief. I undertake that, if at any stage of the selection for empanelment or even after empanelment, any of the information furnished by me is found to be false, incorrect or misleading, then my candidature/appointment/assignment will stand cancelled / terminated without assigning me any reason. I will produce the original documents in support of the information furnished when so ever required by the employer. I also certify that there is no conflict of interest with any concessionaire/stakeholder/staff associated with National Highways Authority of India (NHAI)