1. Designation applied : _________________

(Write clearly JTOs(Telecom) OR JTOs(Civil) OR JTOs (Electrical) as the case may be)

Paste a recent attested Photograph of the applicant [Passport Size]2. Full name of the candidate: ………..…………………………………….

[IN BLOCK LETTER]

3. a) Postal Address with PIN CODE to which

Communication is to be sent: ………………………………………..

[IN BLOCK LETTER]

b) Permanent Home address with PIN CODE: ……………………..

4. a) Date of Birth: __ __ __ __ __ __ __ __

(dd) (mm) (YYYY)

[in the format dd mm YYYY e.g. 1st May 2005 will be 01-05-2005]

[As mentioned in Matriculation or Equivalent Certificate]

b) Age on ………………………..

c) Whether claiming age relaxation? Yes/No ……………………….

If yes, under what category, [Write the relevant category below]

4c.1. Central Govt. Servant/BSNL Employee/Apprentice(BSNL) ……………………….

4c.2 SC/ST/OBC/Ex.Serviceman/PH/ others[To be specified] …………….

5. Father’s Name : ..………………………………

6. State to which the applicant belongs : …………………………………

7. Whether belongs to SC/ST/OBC/General : ………………………………
[Write the relevant category]

8. Whether Physically Handicapped (PH) : Yes/No .……..
[Medical certificate to be attached ]

If yes, write category of PH :-
a) Whether Hearing Impairment OR Locomotive Impairment (To be specified):………………

b) Percentage of disability ………...............

9. Whether undergone Apprentice Training in BSNL successfully ? If so, enclose
documentary proof : ……………

10. Gender: [Male/Female] ……………….

11. Choice of Circle of allotment in order of preference.

[A candidate can choose upto a maximum of five Circles in order of preference. Sixth choice must be “Anywhere in India”. If candidate chooses less than five Circles one of the choice must be written as “Anywhere in India”].
[Name of Circle]
i) Choice 1: ……………...

12. a) Nationality : ………………………….
       b) Whether by birth / by domicile : …………………..

13. Marital status: [Married/Unmarried] ………………..

14. Details of Education/Technical qualifications
[Give details of Degrees obtained only of B.E./B.Tech & above]

14.1 Name of degree with discipline [BE/B. Tech & above] ……………….

14.2 Name of University/ Institute ……………………………

14.3 Month and year of obtaining Engineering Degree …..……..

[Name of Circle]
15. Choice of Examination Centre : ………….…………..

[An applicant can opt for any of the examination centers out of the Circles indicated in Annexure 'A' and submit the application form to the Office of the CGM of the Circle concerned at whose examination centre the applicant wishes to appear]

16. Details of application fee particulars

16.1 Demand draft No. and Date : ………….

16.2 Amount Rs. : ……………………..

16.3 Issuing Bank : ……………………..

16.4 Payable in favour of …………. at ………………

I do hereby declare that all the statements made in the application are true, complete and correct to the best of my knowledge and belief. I understand that in the event of any particular information given above being found false or incorrect, my candidature for the post of Junior Telecom Officer is liable to be rejected or cancelled and in the event of any mis-statement or discrepancy in the particulars being detected after my appointment, my services are liable to be terminated forthwith without any notice to me.

I also understand that if appointed, I would rank junior to any J.T.Os. who had been appointed earlier by the erstwhile DoT/DTS/DTO or BSNL or any other employee in the promotional cadre who had already qualified in the JTOs Examination but not appointed as JTO by BSNL so far.

I understand that if appointed I would have to serve the Circle allotted for the stipulated period of five years.




Date:           
Place:                                                              Signature of the applicant


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