(For office use only)
Application for the Post of Management Assistant
1.0 Personal Information:
1.1 Name with Initials at the end (In English block capitals) :- .......................................................................
.........................................................................................................................................................................
(Ex : GUNAWARDHANA H.M.S.K)
1.2 Name in full (In English block capitals) :- ..................................................................................................
.........................................................................................................................................................................
(Ex : HERATH MUDIYANSELAGE SAMAN KUMARA GUNAWARDHANA)
1.3 Name in full (In Sinhala/Tamil) :- ..............................................................................................................
.........................................................................................................................................................................
1.4 Permanent Address (In Sinhala/Tamil) :- ..............................................................................................
.........................................................................................................................................................................
1.5 Permanent Address (In English block capitals) :- ..................................................................................
.........................................................................................................................................................................
1.6 Gender:- ....................................................................................................................................................
1.7 Marital Status:- .........................................................................................................................................
1.8 National Identity Card No:-
1.9 Date of Birth: - Date Month Year
1.10 Telephone No :
1.11 District :- ...........................................
1.12 Electorate Division:- ...........................................................................................................................
1.13 Grama Niladari Division :- .......................................................................................................................
1.14 Email Address:- .......................................................................................................................................
1.15 Name and address of last school attended:-…………………………………………………………………………………….
2.0 Educational Qualifications:-
2.1 G. C. E. (O/L) Examination: Year: - …………………………………… Index No :- ..................................................
Subject Grade Subject Grade
1. 6.
2. 7.
3. 8.
4. 9.
5. 10.
2.2 G. C. E. (A/L) Examination: Year: - …………………………………… Index No :- ..................................................
Subject Grade
3.0 Professional Qualifications:- ………………………………………………………………………………………………………………..
.....................................................................................................................................................................................
....................................................................................................... ………………………………………………….........
………………………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………………
4.0 Other Qualifications:- ……………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………..
5.0 Non-Related Referees
Name / Telephone No Position Address
1.
2.
6.0 Declaration of the Applicant:
(a) I respectfully declare that the particulars furnished by me in this application are true and correct to the
best of my knowledge. I agree to bear the loss which may occur due to incomplete and /or incorrect
completion of any part of this application. Further, I state that, all sections of this application completed
are true and correct to the best of my knowledge.
(b) I shall not subsequently change any information stated above.
…………………………… ….………………………………...
Date Applicant’s Signature
7.0 Attestation:
………………………………………...……………………………..
I do hereby certify that Mr./Mrs./Miss
is personally known to me and placed his/her signature in my presence on ……………………………
Date …………………………… ….………………………………...
Signature of Certifying Officer
(Either a JP or an Executive Officer of a Government Institution)
Name: .........................................................................................................................................................
Designation: .................................................................................................................................................
Address: .......................................................................................................................................................
8.0 (This part is applicable only for candidates who engage in government employment) Attestation of the
head of the Department/ Institution:
I hereby certify that Mr./Mrs./Miss …………………………………………………………………who is working in this
ministry/department/institution, is working in the post of …………………………………… and his/her work and
conduct are satisfactory, no disciplinary action pending against him/her and no decision has been taken to
impose any such in the future. If he/she will be selected for this post, he/she can/cannot be released from
the service.
Date …………………………… ….………………………………...
Signature of the Head of the
Department or Authorized Officer.
Name: - .............................................................................................................................
Designation:- ..................................................................................................................
Ministry / Department:- ...................................................................................................
