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In the State Child Protection Society, Poojapura

as (8BOru^ai<a>^os a.(iio1(n" njoraroi" Application for the

District a<j)(noo

Application for the Post of

sfl^jo neis<fe6Bi3g1fflej

post of. in

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n(j)(ro f13"

12. oa>(oo(3 miommoRo croosiucaui^j (a>oa^6rog1ra3 (aiacreila Knicsaomo ICPS Executive Committee

II. 2020-o3

O0B>"nJ1<8)

9.(8rani5> (sa6iieics2)1ra3 ^^ctnraS (ajajra

10.^ugO. ^^8^ 6)6)afxice6)3S((n1(a(lra3 (olejoJl^jgg ril^1

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7.(ro(3o96)3<8 <t1(tBao(0(3io>1(o"

63crn1eiui1,9>o

All the facts mentioned above are correct to the best of my knowledge and belief. I haven't applied for the same post

in any other district. Also agree that I have read the general conditions in the notification

Place:

Date:Signature

[SCPS-State Child Protection Society SARA-State Adoption Resource Agency DCPU-District Child Protection Unit JJB-Juvenile Justice Board CWC-Child Welfare Committee CH-Children's Home OH-Observation Home POS-Place of safety)

10.Experience

Remarks% of Mark/Grade

Reg.No &Yearof Pass

Institution/University

Pre-Degree/+2

S.S.L.C

Course

9.Qualification(Use Additional Sheets if needed)

2.

Photo

l.Name (Use Capital Letters Only)

2.Male/Female/TG(Specify)

3.Age & Date of Birth

4.Father's/Husband's Name

S.PIace of Residence(Proof to be attached)

6.Phone/Mobile No

7.e-mail Address

8.Permanent Address (With Pin code)

CH/OH/POS (Specify Dlst)JJB/CWC (Specify Oist)DCPU (Specify Dlst)

SARASCPS

Women and Child Development DepartmentIntegrated Child Protection Scheme[ICPS]

Application for the Post of.

Category No