APPLICATION FOR THE POST OF SURVEYOR-CUM-ASSISTANT DRAUGHTSMAN
DIRECTORATE OF TOWN AND COUNTRY PLANNING 807,ANNA SALAI, CHENNAI - 2.
 
Instructions to the Candidate
* indicates required information
Optional Subject for Written Examination:*
Examination Centre : *
Name in full ( in Capital letters ) : *
Candidate Place of Birth : *
Father's / Husband's Name : *
Father Place of Birth : *
Destitute Widow(Certificate should be enclosed) * Yes No
Persons Studied in Tamil Medium (PSTM Certificate should be enclosed): * Yes No
Differently Abled (Certificate should be enclosed indicating percentage of disability) * Yes No
Whether Ex-Serviceman(Certificate should be enclosed) * Yes No
Sex * Male Female Third Gender
Marital Status * Married Unmarried
Details of Employment
Exchange card,if registered :
Registration No
District in which Registration was Done
Permanent Address (in Capital
Letters with pin code no.) : *
 
 
Pin Code :
  Same as above address
Address For Communication)
(Mobile & Phone No. if any ) :*
 
 
Pin Code :
Email Id : *
Contact Number: *
Date of Birth (as on 01/07/2015) : * (DD/MM/YYYY)
Nationality : * Indian Others
Religion : *
Community
(OC/BC/BCM/MBC-DC/SC/SCA/ST) : *
Name of the Sub Caste : *
Community certificate No: *
Date : *
Issued By :*
Mother Tongue : *
If Tamil is not mother tongue, has the candidate studied Tamil as first language? If yes give details
Criminal Case (Registered/Pending/Punishment awarded) ? * Yes No
Participation in Political Activities (In agitation/As a Member of Political Organization/Candidature in Election) * Yes No
Educational Qualifications:
Sl. No* Course Registration No * Year of
passing *
% of Mark*
Name of the
School/College and University/
ITI/Polytechnic *
1. X std
2.

Additional Qualifications (Technical & Others) :
Sl. No Course Registration No Year of
passing
% of Mark
Name of the
School/College and University/
ITI/Polytechnic *
1.
2.
3.
4.
5.

Previous Experience,if any :
Sl. No Name & address of the Organization Designation held Period Reason for Leaving
From To
1.
2.
3.
4.
5.

Detail of Examination Fees Paid :
Demand Draft No * DD.Amount * Date * Name of Bank,Branch *

Photo / Signature is not uploaded in appropriate place, your application will get rejected

Allowed Photo / Signature Size – 3.5 cm x 4.5 cm (20 KB –40 KB)
 
Photograph of the Candidate *  
Signature of the Candidate*  
Declaration

I hereby declare that the details furnished in this application and the attested copies of certificates submitted are true, complete and correct to the best of my knowledge and belief. In case, if the details furnished above by me are found to be incorrect or false at a later date, I am aware that my candidature/appointment will be liable to be terminated without notice. I declare that I shall not raise any objection on this.

Date :
Place :
Security Code *
Security Code Refresh Code