Office Of The District Land & Land Reforms Office
Purba Medinipur
APPLICATION FORM FOR RECUIRTMENT OF
DATA ENTRY OPERATOR FOR PURBA MEDINIPUR


POST APPLIED FOR*
NAME OF THE CANDIDATE*
FATHER'S / HUSBAND'S NAME*
MOTHER'S NAME*
GENDER*
ARE YOU
 *CITIZEN OF INDIA AS DEFINED IN PART-II OF THE CONSTITUTION OF INDIA
 PERSON WITH DISABILITIES  
 KNOWLEDGE OF ENGLISH AND BENGALI   

DATE OF BIRTH*
  (DD/MM/YYYY)
AGE(as on 01-01-2025)*
  (YEARS)
MOBILE NO*
+91
E-MAIL*
AADHAR CARD NO
PRESENT ADDRESS
VILLAGE / ROAD / TOWN*
BLOCK / MUNICIPALITY / CORPORATION*
POST OFFICE*
POLICE STATION*
DISTRICT*
STATE*
PIN*
PERMANENT ADDRESS (Applicant must be a permanent resident of Purba Medinipur District)
VILLAGE / ROAD / TOWN*
BLOCK / MUNICIPALITY / CORPORATION*
POST OFFICE*
POLICE STATION*
DISTRICT*
STATE*
PIN*
EDUCATIONAL QUALIFICATION
Note: Please fill in the correct details only.
NAME OF THE EXAMINATION
BOARD/COUNCIL/UNIVERSITY
STREAM/
SUBJECTS
%OF
MARKS
YEAR OF
PASSING
(YYYY)
FULL
MARKS
OF
EXAMINATION
TOTAL
MARKS
OBTAINED
MADHYAMIK OR ITS EQUIVALENT
HIGHER SECONDARY OR ITS EQUIVALENT
GRADUATION OR ITS EQUIVALENT
POST GRADUATION OR ITS EQUIVALENT
OTHER CERTIFICATE(IF ANY).
KNOWLEDGE IN COMPUTER
NAME OF THE INSTITUTION
NAME OF THE COURSE
DURATION OF COURSE
(IN MONTHS)
MARKS OBTAINED/
GRADE
YEAR OF
PASSING
(YYYY)
UPLOAD PHOTO
Upload Photo*

# Image size must be within 10 to 50 KB and in .jpeg format. Height- 128px Width-99px
UPLOAD SIGNATURE
Upload Signature*

# Image size must be within 10 to 20 KB and in .jpeg format.Height- 50px Width-200px
UPLOAD AGE PROOF
Upload Age Proof*

# Image size must be within 10 to 100 KB and in .jpeg format.
UPLOAD PERMANENT ADDRESS PROOF
Upload PERMANENT ADDRESS PROOF*

# Image size must be within 10 to 100 KB and in .jpeg format.
UPLOAD GRADUATION MARKSHEET
Upload GRADUATION MARKSHEET *

# Image size must be within 10 to 100 KB and in .jpeg format.
UPLOAD COMPUTER CERTIFICATE
Upload COMPUTER CERTIFICATE *

# Image size must be within 10 to 100 KB and in .jpeg format.
DECLARATION
*I HAVE GONE THROUGH THE NOTICE AVAILABLE IN THE WEBSITE AND FILLED IN APPLICATION FORM ACCORDINGLY. I HEREBY DECLARE THAT ALL THE STATEMENTS MADE BY ME IN THE APPLICATION FORM ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF AND NOTHING HAS BEEN CONCEALED OR SUPPRESSED. I ALSO DECLARE, I HAVE GONE THROUGH THE INSTRUCTIONS NOTED AND ENTERED INFORMATION AS PER INSTRUCTION. I ALSO UNDERSTAND THAT IN CASE, ANY OF MY STATEMENTS IS FOUND INCORRECT OR FALSE DURING ANY STAGE OF RECRUITMENT OR THEREAFTER, I SHALL BE DISQUALIFIED FOR THE POST APPLIED FOR AND I SHALL ALSO BE LIABLE FOR ANY OTHER PENAL ACTION UNDER THE EXISTING RULES WITHOUT FURTHER INTIMATION.

Security Code*