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National Service Volunteers Scheme
APPLICATION FORM
Particulars of the Candidate.
  Name of the Candidate.
  Date of Birth (in Christian Era):
 
Age.
 
Sex: 
 Male Female
  Marital Status: Unmarried Married
   
  Educational Qualifications and institution attended (Beginning with Higher Secondary/ Intermediate Examination)
Name of the Institution From To Examination passed Subjects taken division Year of passing
  District to which belongs.
  Whether belongs to a rural area? Yes No
  If so, indicate number of years spent in villages.
  Postal Address to which communication are to be sent (along with Pin code)
  State/U.T.             
   
  Information in respect of earning head of the family.
  Name:
  Relation:
  Occupation:
  Monthly Income:
  Complete Address:
 
Whether participated in the National Service scheme. (if so, attested copy of the certificate issued by the University/ College indicating the number of years for which participated in NSS may be attached)
 Yes No
  Whether participated in NCC at the College level. (If so, an attested copy of the certificate issue by the college regarding participation in NCC indicating the year of participation, certificate obtained etc. may be attached.) Yes No
  Whether representes the college in any of sports? Yes No
  If so, give details and attach an attested copy in evidence thereof.
  Details of the participation in other important extra-curricular activities/ hobbies.
  Preference with regard to the field of activity in which candidate would like to be engaged. (Indicate the field in order of preference.)
  Whether belongs to Scheduled Caste/ Scheduled Tribe? If so, an attested copy of certificate may be attached. Yes No
  Certificates/ Testimonials to be attached. (Please attach attested copies only)
  Degree or Diploma.  
  Certificate about date of birth (High School/ Higher Secondary)
  Certificate regarding participation in NSS/ NCC/ University level tournament.
  Certificate regarding Scheduled Caste/ Scheduled Tribe.
  Undertaking and Declaration:
  1. I certify that I have read the National Service Volunteer Scheme and understand its implications.
  2. I understand that after the completion of work in the National Service Volunteer Scheme, I will not be able to claim as a right employment in the Agency/ Department where I am engaged.
  3. I understand to abide by the terms and condition of the scheme including that in case I am engaged under the scheme. I will serve the entire period of one year in the project and that I will not leave this work befire the completion of this period.
  4. I undertake to abide by the discipline and the rules of the deploying agency, during the tenure of my engagement as a volunteer with that agency.
  5. I understand that a breach of the above undertaking would entail the termination of my deployment by the deploying agency on one month's notice and that the decision of the deploying agency in this regard shall be final and binding on me.
  6. I certify that I have neither registered myself nor have I applied for registration for enrolment under National Service Volunteer Scheme at any other Nehru Yuva Kendra/ Voluntary Agency.
  7. I declare that the particulars furnished in this application are ture, complete and correct to the best of my knowledge and belief.
Date.   
(Signature of candidate)
Place.  
   

 
   
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