Employment Application Form

Applicant Name (In Block Letters)

First Name :

SUSHANTA

Middle Name :

KUMAR

Surname :

RATH

er's Name

Srinivas Rath

Marital Status :

Married

Sex : Male

Date of Birth : 18.07.1974

Address of Communication :

Qr. No. B-256, Deepanjalinagar

Phase-ll,NTPC,Simhadri,Parwada Mandal,

Dist- Visakhapatnam, (AP)

Permanent Address :

Qr. No. A/ 208, Koelnagar

PO.: Shaktinagar

Rourkela- 14

Dist- Sundargarh, Odisha

Phone N0: 943-***-****, 850*******

E-mail: ac0l02@r.postjobfree.com

Educational / Professional Qualification (From High School Onwards) S. No. Qualification Year of

Passing

% of Marks Division University / Institute

01 H.S.C. 1990 66% 1st BSEO

02 Diploma in

Mechanical

1994 52% 2nd Orissa Board of Technical

Education & Training,

Cuttack

03. Post Diploma in

Industrial Safety

2012 75% 1st

Distn.

SCTE & VT

04 IME (B-Tech) 2016 60% 1st

Distn.

IME

Working Experience: (Starting from your Present Employer (if any) S. No. Name and Address of

employer

Position

Held

Location & Job

Responsibility

Period

From To

01 UTILITY POWERTECH

LTD,SIMHADRI

Safety

Officer

NTPC,SIMHADRI

&SAFETY INCHARGE

05/05/2014 TO

TILL DATE

02 MBECL,MCL-

CHP.BHARATPUR

Safety

Officer

BHARATPUR&ASAFETY

INCHARGE

07/10/2013TO

05/05/2014

04.

MBECL, Marg Karaikal,

Puducherry

Safety

Officer

KPCL Marg Port,

Puducherry

Industrial safety

17.10.2012 to

07.10.2013

05 MBECL, RSP, Rourkel

Safety

Officer

BF# 5, RSP, Industrial

safety

20.03.2012 to

16.10.2012

06 M/s B. B. Kar

MIG-1/57, Sada Colony,

Jamnipal, Korba (CG),

Mob.: 982**-*****

& Type=II/81,

Deepshikha

TSTPS, Kaniha (Orissa)

Mob.: 943-***-****

Mechanical

Engineer

At N.S.P.C.L, Rourkela

under U.P.L.

Operational works of DN

Plant, Chlorinations, CCW

PH, compressiors, CHP Etc.

02.01.2009 to

19.03.2012

07. Shri Balaji Associates

A-Market, Sector-1,

Bhilai (chhattisgarh)

-do- -do- 01.11.2006 to

31.12.2008

08. Baba Construction G.B.

Ralli, Ward No.-1,

Rourkela- 769001,

2600437, Mob.:

933-***-****

-do- -do- 01.09.2004 to

31.10.2006

09. Utkal Industries,

Uditnagar, Rourkela -

769012

-do- At Uditnagar, Rourkela

Maintenance work

05.04.1997 to

31.08.2004

Declaration:

I hereby declare that all the information and particulars given by me in this application are true and correct to the best of my knowledge. I am liable to be disqualified and my appointment is liable to be terminated, if found incorrect or false. Sushanta Kumar Rath

Date:11/05/2017

(Signature of Applicant)

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