CWC/JJB Application Form

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Application Form

Post Applying For:

Chairperson-CWC

Member -CWC

Social Worker Member-JJB

Select Priority of Districts

Select First Priority District

Select Second Priority District

Select Third Priority District

Select Fourth Priority District

Select Fifth Priority District

PERSONAL DETAILS

Name

Residential Address

Mobile Number

Aadhar Number

Email ID

Sex

Male

Female

Transgender

Date of Birth (dd/mm/yyyy):

Disability If Any:

Have you been charge-sheeted, convicted of or pleaded guilty of an offence?

If YES particulars there of and present status:

Have you been associated with any organization that has been blacklisted
OR has been proved of financial fraud?

If Yes Please Explain:

Are you holding a full-time occupation that may not allow
the person to give necessary time to the post applied for?

Are you associated with any Child Care Institution (CCI), directly or indirectly?

Are you an office bearer in any political party?

Have you been declared insolvent ?

Have you been found guilty of misuse of power vested
on you under the Juvenile Justice Act in the past ?

Have you been convicted of an offence involving
moral turpitude and such conviction has not been reversed or he/she has not been
granted full pardon in respect of such offence; ?

Have you served as a Chairperson/Member of CWC/ Social worker Member of the JJB?

If yes, please explain
(the position held and the period for which you held that position):

Are you associated with an organization receiving Foreign Contribution:

Are you working in any Non-Government organization working in the implementation of the act or any organization performing such functions which may cause conflict of interest in discharging duties.

EDUCATION QUALIFICATION

(Please give details of your education track record (from high school to PG)

SI.NO	Qualifications (Degree/PG)with specializations	Education	Name of the College/University	Year of Pass	% of Marks scored
1	10 th
2	Inter
3	Degree
4	PG
5	PHD
1	Any Other

Experience in child related activities (as defined in the JJ Act, 2015 and JJ Model Rules, 2016 (Amended in 2022):

Give details of last 7yrs experience in welfare activities pertaining to children or practicing professional for the post Applied.

Please Check, if you have Relevant work experience.

Name of the Organization	Position held / Designation	Period ( From Date - To Date) (dd/mm/yyyy)		Org Address Phone: Email:	Job Responsibilities	Reasons for Leaving

Upload Certificates

Note: All Certificates File size should be below 100 KB - For Experience and Qualification(Allows only PDF File and upto 1 MB)

Applicant Photo

Applicant Signature

Proof of Age Certificate(SSC Certificate)

Experience Certificate

Certificate of Qualification

Upload Aadhar

Upload Address Proof