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The Date of Receiving Applications is extended till 30th June 2022

Application Form

Select District
PERSONAL DETAILS
Name Residential Address
Mobile Number Aadhar Number
Email ID Sex
Date of Birth Disability If Any:
Have you been charge-sheeted, convicted of or pleaded guilty to 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 work as of the JJ Board
Social Worker?
Are you associated with any Child Care Institution (CCI), directly or indirectly?
Are you an office bearer in any political party?
Have you declared insolvency ?
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 has not been
granted full pardon in respect of such offence; ?
Have you served as a Social worker Member of the JJB?
If yes, please explain
(the position held and the period for which you held that position):
EDUCATION INFORMATION
(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 JJ Act, 2015 and JJ Model Rules, 2016:
[Give details of the last 3 postings (last 7 years whichever is more)
Please Check, if you have Relevant work experience.
Name of the
Organization
Position held /
Designation
Period
( From Date - To Date)
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)
Applicant Photo

Applicant Signature

Proof of Age Certificate(SSC Certificate)
Experience Certificate
Certificate of Qualification