Application Proforma

भारतीय पुनर्वास परिषद्
(सामाजिक न्याय और अधिकारिता मंत्रालय का एक सांविधिक निकाय)
दिव्यांगजन सशक्तिकरण विभाग
भारत सरकार
REHABILITATION COUNCIL OF INDIA
(A Statutory Body of Ministry of Social Justice and Empowerment)
Department of Empowerment of Persons with Disabilities (Divyangjan)
Government of India

Application for Contract basis in National Board of Examination in Rehabilitation (NBER)

Scanned Recent Coloured Passport Size Photograph in.jpg
format size below 200 kb. ★
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Post Applied for ★

1. Applicant's Full name ★

2. Father's name ★

3. Gender★

4. Date of Birth ★

5. Category ★

6. whether belongs to PwD ★

7. Email ★

8. Mobile number★

9. Aadhaar No ★

10. Communication Address★

11. Education & Professional Qualification (From SSC onwords)★

Exam Passed	Board/University	Passing Year	Subjects (max length 300 characters)	Percentage/CGPA

12. Proficiency in Computer/IT (Please specify the level of accomplishment)★

13.Details of Experience / employment,in chronological order starting with the latest★

Name of the Organization	Post held/ Designation	Form	to	Nature of duties

15. Justification with regard to your suitability for the post (max length 1000 characters)★

14. upload documents:★

1.Signature *Click Here to Upload

2.All documents relating to DOB,Academic,Professional Qualification and Experience certificate etc.(single pdf file size not more than 5 MB) to be uploaded duly signed.★ *Click Here to Upload

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I have carefully gone through the Vacancy circular/ advertisement and undertake that information/details furnished above are correct to the best of my knowledge. I also understand that my candidature to the post applied for liable to be cancelled,if any of the above information is found to be false or incorrect.