THE BOILER OPERATION ENGINEER'S RULES,2011
FORM - "A"
(See rules 26 and 41)
APPLICATION FOR CERTIFICATE AND PROFICIENCY
AS BOILER OPERATION ENGINEERS
PART - 1 NAME ETC. OF THE APPLICANT

Note:-
1. Every application must be accompanied with the requisite fee in the manner as may be prescribed by the Government
2. Two copies of a recent post photograph of the Applicant (size 50mm*65mm)must accompany the application with Applicant's signature on the back there of, duly attested by the Gazetted Officer or the Candidate's Employer.
3. Any person making false statement for the purpose of admission renders himself liable for prosecution.
4. Incomplete application is liable to be rejected.

  1. Name (In Full)*
   

 2. 

Father's Name*
   

 3.

Nationality*
   

 4.

Date of Birth *
X
Sun Mon Tue Wed Thu Fri Sat
   
  5. Place of Birth*
   
  6. Permanent Address
  Address Line 1* Pincode*
  Address Line 2 Landline
  District* Email*
  Taluk *
Mobile No*
  Post*    
       
  7. Whether appeared in any previous examination
     
  8. If so, details of Place and Date
X
Sun Mon Tue Wed Thu Fri Sat
   
 9. Mandatory Documents to be submitted:
   *Upload the photograph (size 50mm*65mm)
   *Upload the Signature

                                                                                          PART - II

                                                     PARTICULARS OF ALL CERTIFICATES SUBMITTED

Number of the Certificate

Class of the Certificate

Place of Issue Date of Issue

If at any time suspended or cancelled, and if so state by whom

Date of suspension or cancellation

Reason for suspension or Cancellation

1 2 3 4 5 6 7
 
 *Upload the Certificate Number 1
 *Upload the Certificate Number 2

PART - III

LIST OF TESTIMONIALS AND STATEMENTS OF SERVICE

(The Testimonials to be Numbered Serially Corresponding to the Numbers given in column 1 below )

               

SI.No.of the Testimonials

Date of Testimonials 

Name of the person signing the Testimonials Name and Address of Factory or workshop where employed

Number, Type, Capacity and Heating Surface of Boilers worked on

Capacity in which employed Service of Applicant

Periods for which employed

           

Date of commencement

Date of Termination Years Months Days
1 2 3 4 5 6 7 8 9 10 11
1
2
3
Total Services *                                                             :
Time Served for which Certificates are produced *       :
Time Served for which no Certificates are produced *  :