BIJU YUVA VAHINI
Online Application Form
(
*
) Indicates fields are mandatory
(Open for
female
candidates only, Selection on first come first serve basis. Selection procedure will be as per operational guidelines)
Personal Details(ବ୍ୟକ୍ତିଗତ ସୂଚନା)
First Name (ପ୍ରଥମ ନାମ)
*
Middle Name (ମଧ୍ୟ ନାମ)
*
Last Name (ଶେଷ ନାମ)
*
Mother Name (ମା'ଙ୍କ ନାମ)
*
Father Name (ବାପାଙ୍କ ନାମ)
*
Date Of Birth (ଜନ୍ମ ତାରିଖ)
*
DD
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
MM
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
YYYY
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Gender (ଲିଙ୍ଗ)
*
-- Select --
Female
Adhaar Number (ଆଧାର ନମ୍ବର)
Mobile Number(ମୋବାଇଲ୍ ନମ୍ବର)
*
Alternate No.(ଅନ୍ୟ ନମ୍ବର)
Email Id (ଇମେଲ୍ ଆଇଡି)
District (ଜିଲ୍ଲା)
*
--Select--
Angul
Balasore
Baragarh
Bhadrak
Bolangir
Boudh
Cuttack
Deogarh
Dhenkanal
Gajapati
Ganjam
Jagatsinghpur
Jajpur
Jharsuguda
Kalahandi
Kandhamal
Kendrapara
Keonjhar
Khurdha
Koraput
Malkangiri
Mayurbhanj
Nawarangpur
Nayagarh
Nuapada
Puri
Rayagada
Sambalpur
Sonepur
Sundergarh
Panchayat/ULB (ପଞ୍ଚାୟତ / ସହରାଞ୍ଚଳ)
*
-- Select --
Panchayat (ପଞ୍ଚାୟତ)
ULB (ସହରାଞ୍ଚଳ)
PO(ଡାକ)
*
PS(ଥାନା)
*
Social Details
Current occupation status?
*
Please specify Religion
*
-- Select --
Hindu
Muslim
Christian
Other
Please specify Caste
*
-- Select --
General
SC
ST
OBC
Please specify State of disability .
Educational Qualification & Employment (ଶିକ୍ଷାଗତ ଯୋଗ୍ୟତା ଓ ନିଯୁକ୍ତି)
Qualification/Board (ଯୋଗ୍ୟତା/ବୋର୍ଡ)
Institute/CollegeName (ଅନୁଷ୍ଠାନ/କଲେଜ ନାମ)
PassingYear (ଉତ୍ତୀର୍ଣ୍ଣ ବର୍ଷ)
Grade/Division (ଗ୍ରେଡ୍/ଡିଭିଜନ୍)
8th or 10th Board
Pre University (+2)
Graduation (BA/Bcom/BSC/Oth)
Post Graduation
Others
Please specify current occupation status? (ଦୟାକରି ଆପଣଙ୍କର ବର୍ତ୍ତମାନ ଜୀବିକା ଚିହ୍ନିତ କରନ୍ତୁ।)
--Select--
Student
Volunteer
Working
Others
Skills & Interests(ଦକ୍ଷତା ଏବଂ ଆଗ୍ରହ)
Have you ever done any voluntary work before? (yes/no)
(ପୂର୍ବରୁ ଆପଣ କୌଣସି ସ୍ୱେଚ୍ଛାସେବୀ କାର୍ଯ୍ୟ କରିଛନ୍ତି କି? (ହଁ/ନା))
Yes(ହଁ)
No(ନାଁ)
If yes, please list the previous voluntary work experience
(ଯଦି ହଁ, ଦୟାକରି ପୂର୍ବରୁ କରିଥିବା ସ୍ୱେଚ୍ଛାସେବୀ କାର୍ଯ୍ୟ ସମ୍ପର୍କରେ ଉଲ୍ଲେଖ କରନ୍ତୁ।):
Organization/Youth Agencies (ସଂଘ/ ଯୁବ ସଂସ୍ଥା)
Volunteer Activity (ସ୍ୱେଚ୍ଛାସେବୀ କାର୍ଯ୍ୟକଳାପ)
Why do you want to volunteer now? What has motivated you to become a member of Youth Brigade?
(ବର୍ତ୍ତମାନ ଆପଣ କ'ଣ ପାଇଁ ଭଲ୍ୟୁଣ୍ଟର ହେବାକୁ ଚାହୁଁଛନ୍ତି ? କେଉଁଥିରୁ ଅନୁପ୍ରାଣିତ ହୋଇ ଆପଣ ଯୁବ ବାହିନୀର ସଦସ୍ୟ ହେବାକୁ ଚାହିଁଲେ ?)
Please mention your skills/strength for voluntary work. (ଦୟାକରି ଆପଣଙ୍କର ସ୍ୱେଚ୍ଛାସେବୀ କାର୍ଯ୍ୟ ପାଇଁ ରହିଥିବା ଦକ୍ଷତା/ସାମର୍ଥ୍ୟ ଉଲ୍ଲେଖ କରନ୍ତୁ।)
Have you worked with any volunteer organization in past?(ପୂର୍ବରୁ ଆପଣ କିଛି ଭଲ୍ୟୁଣ୍ଟର ସଂସ୍ଥାରେ କାର୍ଯ୍ୟ କରିଛନ୍ତି କି ?)
--Select--
NSS
NCC
Bharat Scouts & Guides
Red Cross
Others
What kind of voluntary works interests you? (କେଉଁ ପ୍ରକାର ସ୍ୱେଚ୍ଛାସେବୀ କାର୍ଯ୍ୟରେ ଆପଣଙ୍କର ଆଗ୍ରହ ଅଛି?)
--Select--
Child Marriage
Child Labour
Community Sports Promotions
Dowry Elimination
Drug Abuse
Education
Environment
Migration
Nutrition
Sanitation & Hygiene
Health & Health Promotion
Any Other
What is the one change you would like to see in Odisha? (ଓଡିଶାରେ କେଉଁ ପ୍ରକାରର ଏକ ପରିବର୍ତ୍ତନ ଆପଣ ଦେଖିବାକୁ ଚାହୁଁଛନ୍ତି ?)
NOTE!
The information you provide will be stored in confidence under the provisions of the Data Protection Act. The completed form will be held securely and confidentially. (ଆପଣ ପ୍ରଦାନ କରିଥିବା ସମସ୍ତ ସୂଚନା ତଥ୍ୟ ସୁରକ୍ଷା ଆଇନ ଅନୁଯାୟୀ ସୁରକ୍ଷିତ ରହିବ। ଆବେଦନ ପତ୍ରଗୁଡିକୁ ସୁରକ୍ଷିତ ଓ ଗୁପ୍ତ ରଖାଯିବ।)
Referance Details
First Name
Middle Name
Surname.
Mobile Number
Email Id