Application Form for Engagement of Chief Information & Security Officer (CISO) on Contract Basis

Page 1 of 8 CHIEF INFORMATION SECURITY OFFICER (CISO) APPLICATION FORM FOR CONTRACT - BASED POSITION APPLICANT INFORMATION Field Details Post Applied For Chief Information Security Officer (Full - time) on Contractual Basis Name (Mr. / Mrs. / Ms.) _________________________________ Father's/Husband's Name _________________________________ Date of Birth ____ / ____ / ____ (dd/mm/yyyy) Age as on 01. 0 6 .202 6 __________ years __________ months Gender  ☐ Male ☐ Female ☐ Other Marital Status  ☐ Single ☐ Married ☐ Divorced ☐ Widow(er) Category  ☐ General ☐ OBC ☐ SC ☐ ST Whether PWD  ☐ No ☐ Yes (Please specify: ___________) ☐ VI ☐ HI ☐ OC ☐ MD (% of disability: ______%) *VI - Visually Impaired; HI - Hearing Impaired; OC - Orthopedic Conditi on; MD - Multiple Disability ID DETAILS FIELD DETAILS AADHAR NUMBER PAN NUMBER *Relevant documents to be attached ADDRESS DETAILS : Present Address: FIELD DETAILS BUILDING & STREET NAME CITY/TOWN DISTRICT STATE PIN CODE Page 2 of 8 PERMANENT ADDRESS: FIELD DETAILS BUILDING & STREET NAME CITY/TOWN DISTRICT STATE PIN CODE CONTACT DETAILS FIELD DETAILS

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