MANAGE PROFILE(FORM-A)

(see rule 9(1))

Application for the (Grant) of

(Please Tick ✓ whichever is applicable)

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Personal Details

First Name

Middle Name

Last Name

Father`s Name

Applicant`s Date of birth

Full Postal Address

House No

Street/Lane

Area(Block/Ward/Panchayat)

City/Town/village(Tehsil)

District

State

Pincode

Aadhar Number

Landline Number

Work Experience

Details of Present and past service (to be supported by copies Certificates) Add Work Experience

Name Employers	Date of Joining	Date of Leaving	Total Period of service (years)	Action

Educational Details (Technical)

Educational Details (Technical) Add Education Details

Name of Technical Institute and School	Degree/Certificate	ENROLLMENT NUMBER	Period of Education (years)	Score (%)	Name of Firm	Duration of Training (months)	Action

Medical Certificate

I hereby declare that I am medically fit to undertake Electrical work, as stated in the Medical Certificate issued by (Name of Doctor)

working in (Name of Hospital/Dispensary) as (Practitioner/Medical ID) (See rule 8(1) and 8(2))

Attachements "Kindly DO NOT upload copy of Aadhaar ID in any of the sections given below."

Upload Regarding Documents
Education Degree/Certificate

Upload Marksheets:

Date Of Birth Proof:

Medical Certificate:

Experience Certificate:

Existing Permit/Certificate Copy(To be uploaded by applicants who are applying on basis of old certififcate/permit):

FIR Copy(To be uploaded by applicants who are applying on basis of old certififcate/permit) :

Affidavit:

Undertaking:

Other Documents2:

I hereby declare that application is accompanied with the document as specified under sub-rule (2) of rule (10) of the Rajasthan Electrical Inspectorate (Formation of Technical Committee and Grant of Licence, Competency to work and permit to work) Rules, 2016”
I do hereby declare that the particulars given above are correct. If any Information is found incorrect my application can be cancelled.

Date

*Please crop and upload only JPG/JPEG/PNG Image

#	Supervisor Class	For candidate seeking permit to work as supervisor (without Examination mode)
1.	A-Class (For any voltage level)	(A) Candidates who have B.E or B. tech in Electrical Engineering. (B) Have a wireman permit issued by Electrical Inspectorate and. (C) Have at least five years of valid experience in operation and maintenance of electrical installations. OR Candidates who have valid experience of B Class supervisors for at least five years.
2.	B-Class (Voltage upto 33 KV and below)	(A) candidate who have a wireman permit issued by Electrical Inspectorate of Rajasthan and (B) at least ten year of valid practical electrical works experience in the State of Rajasthan as electrical contractor of Class A/B/C or by head of the office / section in charge of any state/ Central Government / Board/ Corporation having license for dealing or handling with electrical works. OR Supervisors who have passed two year ITI recognized by any state Government and having certificate of competency and permit to work as supervisor issued by competent authority of other States.

I have read eligibility conditions for supervisor