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Recruitment of Officer Sca le -II, Officer Scale -I & Office Assistant (Multipurpose)

Last Modified On: 23-12-2011 No Of Times Modified: 2

1303

Please paste your recent

passport size photograph

and sign across it. Please

retain atleast 5 copies of

same photograph with you

for subsequent use.

Registration #: 12505

Full Name : Fredrick Pohlong

Post : Officer Junior Management (Scale-I)

Post Code : 02

Category : ST

If Person with Disability : NO

Type of Disability : -

Percentage of Disability : -

Do you intend to use the services of a scribe (only for VI & OC candidates whose writing

speed is affected by cerebral palsy) :NA

Whether domiciled in Kashmir Division of the State of J & K

during the period 1-1-1980 to 31-12-1989 ? :NO

Whether you belong to Religious Minority Community : YES

Religion to which you belong : Christian

Are you an Ex - Serviceman ? : NO

Are you a disabled Ex-Serviceman (DISXS) ? : NO

Period of Service (in months) : --

Are you a Dependent of an Ex-Serviceman (DXS)? : NO

Are you seeking Relaxation under Widow, Divorced women & women

judicially separated from their husbands & who are not remarried ?:NO

Are you domicile of Meghalaya ? : YES

Do you know local language of Meghalaya? : YES

Nationality : indian

Centre of Examination : SHILLONG

Centre code : 11

Application Fee / Postal Charges Details :

Payment In : MEGHALAYA RURAL BANK

Transaction ID/ Journal No. : 90811

Branch Name : shillong

Branch Code No. : 01

Date of Deposit : 19-12-2011

Amount : 100

Personal Details :

Date of Birth : 12-09-1979

Age completed as on 01.10.2011 : 32

Gender : MALE

Husband's Name/Father's Name : emillius khonglah

Mother's name : nargis pohlong

Contact Details:

Address for Correspondence : Rynjah

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Total Experience (in months) : -

Have you worked for two years as an

officer in Bank or Financial

Institution? :

NO

Lumshngain

Shillong

District : East Khasi Hills

State : MEGHALAYA

Pin code : 793006

Permanent Address : Rynjah

Lumshngain

Shillong

District : East Khasi Hills

State : MEGHALAYA

Pin code : 793006

Email ID : pohlongfredrick624@gmail.com

Phone Number : -

Mobile Number : 9856654876

a) Qualification Details(as on 01.10.2011):

Exam Passed Subject /Stream Year of Passing % of Marks

Graduation / Equivalent : Arts 2002 39.22

Post Graduation : MTA 2006 53.38

Professional qualification: : MTA 2006 53.38

Knowledge of Computer : YESDetails of computer Knowledge qualification : INTERNET

Post Qualification Work experience details (As on 01.10.2011) :

Name of the

Employer

Designation and Rank if

any

From(mm/yyyy) To(mm/yyyy) Nature of duties

performed

Nature of duties

performed

Length of Service

(YY/MM)

Other Details :

Languages Known Read Write Speak

ENGLISH YES YES YES

KHASI YES YES YES

JAINTIA YES YES YES

HINDI NO NO YES

DECLARATION:

I hereby certify that the information furnished above is correct to the best of my k nowledge and belief. I have not suppressed any material fact or factual information in the above statement. I

am aware, that, in case, I have given wrong information or suppressed any material fact or factual information or, I do not satisfy the eligibility criteria according to the advertisement, then my candidature

will be rejected/services terminated even after permanent employment without giving any notice or reasons thereof.

I hereby certify that I am satisfying the eligibility criteria for the post applied for in terms of the advised criteria in respect of age, educational qualification and experience, etc.

I am also willing to serve anywhere in India. I agree that the Bank has the right to transfer me to any part of the country and/or to any job position at its sole discretion in

terms of applicable staff rules from time to time.

I hereby agree that any legal proceeding in respect of any matter(s) or claims or disputes arising out of this application or out of said advertisement can be instituted by me only at Shillong

and Courts/Tribunal/ Forums at Shillong only, shall have sole and exclusive jurisdiction to try any cause/dispute. I undertake to abide by all the terms and conditions mentioned in the advertisement

given by the Bank.

Place:

Date: 20-12-2011 Signature of Applicant

Fredrick Pohlong

Please retain your Registration No. and Password emailed to you carefully for further reference

NOTE: Please DO NOT SEND application print-out to the Bank

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