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The South Canara District Central Co-operative Bank Ltd
Uthkrushta Sahakari Soudha, Post Box No. 721, Kodialbail, Mangalore
Application for Recruitment to the Post of II Division Clerk
 
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 Personal Details
Full Name of the Candidate (in block letters): 
 : 
Date of Birth:  / /       Gender:  Male   Female      Marital Status:  Married   Unmarried
 Address for correspondence
Address for correspondence: 
City:    Pin:     State: 
Email Address:     Mobile:    Phone: 
 Permanent Address
 Same as Correspondence Address
Permanent Address: 
City:    Pin:     State: 
Email Address:    Mobile:    Phone: 
 Education Details
 1) Qualifying Examination passed & Percentage of marks (copy of the certificates should be enclosed)
Qualification Max marks Secured marks Percentage
SSLC
II PUC
Qualification Degree Type Agg. Max marks(All Years) Agg. Secured marks(All Years) Percentage
Graduation
Post Graduation
 2) Higher Qualifications, if any, Percentage of Marks (copy of the certificate should be enclosed):
     
 3) Qualifying Examination Passed in Computer (copy of the certificates should be enclosed):
     
 4) Experience, if any, specify nature, period, salary drawn and name of the institution(copy of the certificate should be enclosed):
    (a)
    (b)
    (c)
 Payment Details
 Select the mode of Payment :
Name of the Bank:    DD Number:     Amount:    
DD Date:  (Copy of the Cash Receipt/DD should be enclosed)
SCDCC Bank Branch Name:    Amount:    
Payment Date:  (Copy of the Cash Receipt/DD should be enclosed)
 Other Details
 1) Category of Candidate:  (Copy of the Certificate should be enclosed)
 2) Whether coming under Ex-Serviceman?  Yes   No (Copy of the Certificate should be enclosed)
 3) Whether coming under Physically Handicapped?  Yes   No (Copy of the Certificate should be enclosed)
 4) Have you ever been prosecuted, Kept under detention or bound down / fined, convicted by a Court of Law for any offence?
    Is any case pending against you?  Yes   No
    If the answer is YES, furnish particulars:
 5) Have you ever been removed from service or debarred from service of any organization or institution?  Yes   No
    If so furnish particulars:
 I hereby declare that the particulars furnished by me are true to the best of my knowledge and belief.
 Place: 
 Date: 
Signature of the Candidate             
 Instruction to the Candidate
 Completed application form along with the following certificates in addition to the certificates mentioned in the notification should reach,
      The Chief Executive Officer
      The South Canara District Central Co-operative Bank Ltd
      Uthkrushta Sahakari Soudha, P.B. No. 721, Kodialbail, Mangalore - 575003,
      On or before the last date stipulated in the notification.
      The envelope containing the application should be superscribed as
      "Application for Recruitment to the Post of II Division Clerk"
 (a) Counterfoil of the cash paid challan or DD for Rs.500 + GST of Rs.90 = Total Rs.590/- in case of SC/ST Candidates and Rs.1000+GST of Rs.180 = Total Rs.1180/- for others should be enclosed with application form.
 (b) Copies of the marks card of S.S.L.C or equivalent examination showing the date of birth for proof of age.
 (c) Self-Attested Copies of all the marks card along with all the required certificates should be produced in support of qualification, higher qualification, reservation and experience.
 (d) Candidate in service should submit their application through their employer.
 (e) Candidate coming under Ex-servicemen/ Physically Handicapped should enclose Certificate in the prescribed form.
 (f) Person belongs to SC/ST/I/II(a)/II(b)/III(a) & III(b) must submit certificate obtained from the competent authority in the prescribed form.
 For Office use only
 Date of receipt of the application: 
 Result of Scrutiny: 
 
 
Signature of the officer