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 empanelment of Experts in the field of Legal/IT/Media/Accounts &Administration - last date 31 March,2025.

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format size below 200 kb. ★
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1. Area of Expertise ★

2. Name ★

3. Date of Birth ★

4. Gender ★

5. Full Address of Correspondence ★

6. State ★

7. District ★

8. Pin code ★

9. Father Name ★

10. Category ★

11. whether belongs to PwD ★

12. Email Id ★

13. Mobile number ★

14. Landline No with STD CODE (If any)

15. Aadhar No. ★

16. Academic Qualification ★

Academic Qualification	Board/University	Passing Year

17. Professional Qualification ★

Professional Qualification	Board/University	Passing Year

18. Experience ★

Department/Organization Name	Post Held & Pay Scale	From	To	Nature of Duties

19. Details of courses/ training programmes attended,if any

20.Total Emoluments drawn per month

21. Additional details about Present employment

22. Any Other information

23. Upload Section: ★

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 1 MB) to be uploaded duly signed. ★ *Click Here to Upload

I do hereby declare that information furnished above is true and based of documentary evidence to the best of my Knowledge and belief. In case of any information found fake or incorrect, my candidature shall be liable to be summarily and any appropriate action may be initiated against me.

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