Candidates May Use Separate Sheet, If Required)

Annexure-I
ODISHA MINING CORPORATION LTD

APPLICATION FORMAT FOR RECRUITMENT Affix recent colour
pass port size
1. Post applied for :.............................................................................................
photograph.
2. Advertisement No. and date: Advt. No 80 /OMC dated 19.08.2023
3. Full Name (In capital):....................................... .......................................
4. Father’s /Husband’s Name:.........................................................................
5. Date of birth :..........................................................................
(As recorded in HSC or equivalent exam) (Attach copy of certificate)
6. Age as on (31.07.2023) :..............................
7. Sex :……………………………………
8. Category :………………………………….
9. Marital status: (Married/Un-married) ........................................................
10. Address (with PIN code):
Present Address Permanent Address
11. Contact details: (a) Phone …………………………………………

(b) e-mail ………………………………………….
12. Qualification: (10th onwards) & addl. qualification, if any(Attach copy of certificates& mark
sheets).{Candidates may use separate sheet, if required}
Sl. Exam Name of the Duration Whether Year & Maxi Marks % of
No. passed/ Board / of Regular month of mum obtained Marks/
*
discipline University / course course Passing marks CGPA
Institute (Yes/No)
(*In case of CGPA/grades, please indicate equivalent percentage as per norms adopted by the
University/ Institute & attach a copy of such norm fixed by the concerned University/Institute)
13. Post Qualification Experience (By clearly mentioning the date of joining & date of leaving/
continuance in the organization(s) worked/working. Further, the positions held by the candidate in
each organization worked/working to be specified clearly){Candidates may use separate sheet, if
required}:
Sl. Name & Post Scale of Cost to Duration of Total years Type of
assignment
No. address of held Pay and Company Experience & months
handled/specific
Organizations Basic (CTC) (DD/MM/YYYY) of nature of
worked Pay Date of Date of experience work/duty
Joining leaving/ performed
continua
nce
Note: Copy of the experience certificate (s) as per the above particulars must be attached.
14. Whether applied earlier in OMC, if yes, please mention the posts applied for…………………………… &
Whether appeared for Personal Interview in OMC, if yes, please mention the post appeared
for…………………...
15. No. of days/months required to join, if selected:………………………………..
DECLARATION
I.............................................Son/Daughter/Wife of……………………………………………………….
do hereby declare that all the statements made in this application are true and correct to the
best of my knowledge and belief. In the event of any information being found false, my
candidature/appointment is liable to be cancelled/ terminated without any notice to me.
(SIGNATURE IN FULL)
PLACE: ............................ NAME: …………………………………………….
DATE: ............................
NB: Documents/ Certificates to be attached (Please put√ mark):-
Sl. No Name of Documents Put √ Page No.
mark
From To
1 10thCertificate
2 10thMarkSheet
3 +2/Intermediate Certificate
4 +2/Intermediate Mark sheet
5 Degree Certificate
6 Degree Mark sheet
7 Post-Graduation Certificate, if
any
8 Post-Graduation Mark sheet,
if any
9 Proof of CGPA to Percentage
conversion formula
10 Relieving/ Continuance
Certificate (or latest
pay slip) if applicable
11 Experience Certificate(s)
12 Why I consider myself

suitable for the Role
13 Others, if any:1
14 2
15 3……
Total Nos. of attachments to the application…………………………
Signature of the applicant
The documents to be attached must be self-attested with proper numbering of the pages.

Candidates May Use Separate Sheet, If Required)

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Annexure-I

ODISHA MINING CORPORATION LTD

Present Address Permanent Address

11. Contact details: (a) Phone …………………………………………

15. No. of days/months required to join, if selected:………………………………..

12 Why I consider myself

Total Nos. of attachments to the application…………………………

Signature of the applicant

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