FORMAT OF APPLICATION APPLICATION FOR THE POST OF LDC 1. Name in Full (in block letters): ___________________________________ 2. Sex (Tick
Appropriate Box) :

Male

Female

Affix recent passport size photo duly attested by Gazetted Officer

3. Date of Birth : _____/______/________ DAY/MONTH/YEAR 4. Name of Father/Husband :

Candidate signature

5. Address for communication (in block letters with Pin code ) ___________________________________________________________________________________________ ___________________________________________________________________________________________ ______________________________________________________________ City : _____________________________________________ Pin code 6. Whether belongs to : Gen (Tick
appropriate box)

SC

ST

OBC

Physically Handicapped

Ex-Servicemen

7. Educational qualification (attach attested copy of the certificate) Sr.No

Exam passed

Name of Board

Year of passing

Roll Number

Percentage of marks secured

Class

8. Details of payment of fees : Bank Name: ______________________________________ Branch name __________________________ Amount of Demand Draft Rs. _____________ Demand draft No. ______________ D.D. Date : ___________ I do hereby declare that the statements made in the application are true, complete and correct to the best of my knowledge and belief. I understand and agree that in the event of any information being found false or incorrect or incomplete of ineligibility being detected at any time before or after selection/interview, my candidature is liable to be rejected. I shall be bound by the decision of the competent authority. Place : ____________________ Date : ____________________ Check list for enclosures (please put

Candidate’s Signature




tick mark in the box)

1) Age proof (XII certificate)

2) Caste certificate (if belong to SC/ST/OBC)

3) Certificate of proof, if belong to PH/Ex-SM/Sportsman

4) Educational Qualification

5) Demand Draft

6) Photograph

7) Self-addressed stamped (Rs. 10) envelope

EMPLOYEES STATE INSURANCE CORPORATION (MINSITRY OF LABOUR, GOVERNMENT OF INDIA) Regional Office, EDC Plot No. 23, Patto Panaji – Goa 403 001

RECRUITMENT OF LDC Applications in the format given in this advertisement are invited for filling up the following vacancies in Goa Region of the ESI Corporation. The break-up of the vacancies is as follows:Genl. 01

OBC 01

Total 02

Vacancies are subject to change. A. Examination Centre: Panaji. B. Pay & Allowance: The post will carry the pay scale of Rs. 5200 – 20200 + 1900 Grade Pay, plus allowance, as admissible to the employees of ESIC. Starting pay will be 5830 + 1900 Grade pay. C. Age limit: Between 18-27 years as on 30/04/2010. Age relaxation: a) 5 years in case of SC/ST candidates. b) 3 years for other backward classes as notified by the Govt. of India. c) In case of Ex-servicemen period of service rendered in the Armed forces plus 3 years. d) In case of physically handicapped persons 10 years. e) Relaxable in the case of E.S.I. Corporation employees and Govt. servants as per rules. D. Qualification: i) Higher secondary passed (passed 12th standard or equivalent from a recognized board or educational institute.) ii) Working Knowledge of Computer including use of office suites and data base. E. Fee & Mode of payment: A demand draft for Rs. 75/- (Rupees Seventy Five only) drawn in favour of State Bank of India or its associate banks. (State bank of Hyderabad/Mysore/Travancore/Indore/Patiala/Bikaner & Jaipur/ Saurashtra) in favour of E.S.I. Corporation and payable at Panaji. Candidates belonging to SC/ST/PH/Ex-servicemen categories and employees of ESI Corporation are exempted from payment of examination fee. Criteria for reservation of the physically handicapped persons and sportsmen will be as per Govt. of India instruction. NOTE: i) Fee once paid will not be refunded under any circumstances. ii) Demand draft drawn should be on State Bank of India or its associate bank obtained on or after publication of the advertisement. iii) Fees paid by any other mode will not be accepted. iv) The candidate must write his/her name and address on back of the Demand draft. F. Scheme of Examination : a) The Lower Division Clerks examination will consist of two parts viz :Part I: - The written test will consist of one paper for 200 marks containing 4 parts: (i) English language (ii) General Intelligence & General Aptitude (iii) Numerical aptitude and (iv) General awareness. Each question shall carry one mark. The question in all the four parts will be of objective type (multiple choice) ones. Except English language the other questions will be in English/Hindi. The examination will be of 03 (three) hours duration. Part II :- The Corporation reserves the right to admit only that much candidates as considered necessary by it for the skill test in knowledge of computer, including use of office suites and data bases, based on the performance of candidates in Part-I written test. G. How to apply: Application strictly as per format printed in this advertisement shall be sent in an envelope super scribing “Application for the post of L.D.C.” to the following address by Regd. Post/Speed Post. THE REGIONAL DIRECTOR EMPLOYEES’STATE INSURANCE CORPORATION REGIONAL OFFICE GOA PANCHDEEPBHAVAN EDC PLOT NO. 23, PATTO PANAJI – GOA – 403 001.

The following documents should be attached with the application form: i) Two copies of recent passport size photographs duly attested by a Group “A”/Group “B” Gazetted Officer with one photograph pasted on the application form. ii) Attested copies of certificate and testimonials in proof of age/date of birth/educational qualification/caste/experience, etc. iii) Attested copy of community/status certificate in the prescribed form in case of candidates belonging to SC/ST/OBC/Ex-Servicemen categories. Candidates claiming reservation/age relaxation on grounds of belonging to the OBC, should submit the community certificate in Annexure ‘A’ prescribed vide Govt. of India Department of personnel and Training OM No.36012/22/93-Estt (SCT) dated 8.9.93 and modified vide G.O.I. DOPT’s OM No. 36033/3/2004-EST(Res) dated 9.3.2004, failing which the benefit of reservation or age relaxation will not be given. iv) One self addressed and stamped (stamps worth Rs. 10/-) envelope of size 23 cms x 10 cms. v) Demand Draft of Rs. 75/- drawn in favour of Regional Director ESI Corporation and payable at Panaji. Those candidates who are employed in Govt./Semi-Govt./Autonomous bodies etc. should send their application through “proper channel”. However they may send an advance copy of their application along with demand draft and other certificates and testimonials so as to reach this office before the due date. NOTE - I : The application and other documents should be arranged in the following order one below the other and tightly tagged or stapled on the left hand side top corner. 1) Additional photograph. 2) Application form. 3) Attested copies of certificates 4) Self-addressed envelope. NOTE – II : The Demand Draft should not be tagged or stapled but should be pinned or clipped at the bottom of the application form. H. The last date for receipt of application form is 30/04/2010 up to 5.15 p.m. I. General Conditions : 1. A candidate should submit one application only. Submission of more than one application may lead to rejection of all the applications submitted. 2. Mere submission of the application does not confer any right on the applicant to be called for written test. 3. Application should be submitted strictly in the prescribed format only and all columns should be filled up in block/capital letters in the candidates own handwriting. 4. Application should be sent in a cover superscribed as “Application for the post of LDC” by Registered post/speed post, so as to reach the Regional Office, ESI Corporation, PANCHDEEP BHAVAN, EDC PLOT NO. 23, PATTO PANAJI GOA – 403 001 BEOFR DUE DATE. 5. Incomplete/unsigned applications received without photographs certified copies of required certificates such as educational qualification, caste/community etc. and those received after the prescribed last date for receipt of application will summarily be rejected without any communication to the candidate. 6. No TA/DA will be paid to any candidate including SC/ST candidates for appearing in the written test. 7. Wrong declaration/submission of false information or any other action contrary to law shall lead to cancellation of the candidature at any stage. 8. No interim correspondence will be entertained. CAUTION: Canvassing in any form will be disqualification and shall lead to cancellation of the candidature.

REGIONAL DIRECTOR

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