Employee's state insurance corporation Delhi
application for LDC's in Delhi State.
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Personal Details
Paste your recent passport size photograph attested by a Gr.”A”/Gr.”B”/ Gazetted Officer.
*
Full name
*
Gender
select
Male
Female
*
email
*
Father/Husband's Name
Mother's Name
*
Date of Birth
In Figures
You are Indian By birth
Yes
No
*
Permanent Address
*
State
select one
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chhattisgarh
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Orissa
Punjab
Rajasthan
Sikkim
Tamil Nadu
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
Delhi
Pondichery
Chandigadh
Andman and Nicobar island
Daman and Diu
Dadra and Nagra haweli
Lakshdweep
*
Pin
Landline No.
STD code
-
Mobile
Contact Details
*
Mailing Address
*
State
select one
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chhattisgarh
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Orissa
Punjab
Rajasthan
Sikkim
Tamil Nadu
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
Delhi
Pondichery
Chandigadh
Andman and Nicobar island
Daman and Diu
Dadra and Nagra haweli
Lakshdweep
*
Pin
Landline No.
STD code
-
Mobile
Category you belong to
General-01
SC-02
ST-03
OBC-04
You are Physically Handicapped
Select
VI
HI
OH
Percentage of Disability
Employee of ESIC
Ex-Serviceman
Others
Experience(in year)
DD Details
*
Issuing Bank of DD
*
DD Number
*
Issuing Date
*
Amount
Language Known
Speak
Read
Write
Hindi
English
Other
Education Qualification
Sr. No.
Qualification
University/Board
Subject
Marks in %
Remarks
1.
Matriculation
*
2.
Sr. Secondary
3.
Graduation
4.
Post Graduation
5.
Other if any
Computer Skills
Name of Certificate/Diploma
Duration(in month)
Knowledge of
Typing Speed
MS Office
Language
English
Hindi
Speed (in wpm)
select one
20-25
25-30
30-35
35-40
45-50
select one
20-25
25-30
30-35
35-40
45-50
Database/Dbase/FoxPro/Access
Programming
Work Experience
Sr. No.
Name of Employer
Addressof Employer
Designation/Duties
Salary (per annum)
Working period
1.
From
To
2.
From
To
Other Educational Achievments, extra-curriculam activities, Occupational Achievment etc.
List of Enclosers
Metric
Cast Cert.
Ex- Sreviceman
Demand Draft
PH
Sr. sec.