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ON-LINE APPLICATION FOR TNPSC REGISTRATION

21032
Registration # : 2661132

Full Name :

M RADHAKRISHNAN

One Time ID : Name of The Post Applying for : Are you a Destitute Widow? : Are you a Differently Abled Person? : Are you an Ex-Serviceman ? : PPO No : Date of Discharge / Probable Discharge / Date : Are you a Government Employee? : Nationality / Citizenship : Application Fee / Intimation Charges details: Payment Mode: Amount : Personal Details : Date of Birth : Gender : Married : Spouse's Name : Religion : Candidate's Place of Birth : Native District : Father's Name : Father's Place of Birth : Mother Tongue : Mother's Name : Spouse's Name : Communal Category : Name of the SubCaste : Certificate No : Date Of Issue : Issuing Authority : Taluk : District : Address for Correspondence :

11851899 CSSE-I NA NO NO --NO Indian

Net Banking 100.00

22/06/1984 MALE Yes KARTHIKA Hindu SALEM Salem A MADHAVAMANI Salem Tamil M KALAVATHI KARTHIKA Backward Class(BC) DEVANGAR 2401792 30/05/1991 Head Quarters Deputy Tahsildar Rasipuram Salem 55, ARUMUGA IYER NAGAR 1st STREET KANNANKURUCHI

District State : Pin : Permanent Address :

Salem Tamil Nadu 636008 55, ARUMUGA IYER NAGAR 1st STREET KANNANKURUCHI

KANNANKURUCHI District State : Pin : Contact Details : Email ID : Mobile No : EDUCATIONAL QUALIFICATION PARTICULARS : Exam Passed S.S.L.C : H.S.C : Degree : Others : Whether studied Tamil as one of the subject : Details regarding the prescribed qualification : Qualification Details : Other Equivalent Qualification Details : Certificate No : Year of Passing : Name of the Authority/ University : Preferential qualification for per notification : Preferential qualification 1 Preferential qualification 2 Preferential qualification 3 Preferential Physical Standards for per notification : Any Degree -168746 2010 ANNA UNIVERSITY Yes Professional Degree (B.E, M.B.B.S.,B.V.Sc.,Agriculture,Nursing & Others) --Yes English Type writing / Short hand Qualification Type Writing Short hand Name of the Examination Centre District: Name of the Examination Centre : Compulsory Subject (apart from General Knowledge) : Do you claim Age Concession? : Do You Claim Fee Exemption? : Post Preference : Criminal Case (Registered/Pending/Punishment awarded) : Participation in Political Activities (In agitation/As a Member of Political Organisation/Candidature in Election) : Post Qualification work experience (Start from present Employer) : Name of the Organisation Previous appearance for Oral Test / Written Test Name of the Post Register No. Year Designation From(mm/yyyy) To(mm/yyyy) Nature of Duty Salem Salem General Knowledge with Tamil No No -Not Applicable Not Applicable --Tamil --Year of Passing 1999 2001 2010 Medium of Instruction English English English Degree N/A N/A others -degree Major Subject N/A N/A ECE radhakrishnan226@gmail.com 9994014990 Salem Tamil Nadu 636008

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DECLARATION:
1. I hereby declare that all the particulars furnished in this application are true, correct and complete to the best of my knowledge and belief. In the event of any information being found false or incorrect or ineligibility being detected before or after the examination, action can be taken against me by the TNPSC. 2. I hereby declare that I will not be a party to any kind of canvassing on my behalf.

3. I further declare that I fulfil all the eligibility conditions prescribed for admission to the examination.

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4. I have informed my employer in writing that I am applying for this Examination.

5. I have gone through the Instructions etc. to candidates and the Commissions notification for this Recruitment before filling up the application form.

6. I declare that I possess the medical standards prescribed for the post(s) which I am now applying.

7. I certify that I have not been debarred by the TNPSC or any other recruiting agency.

8. I am not a dismissed Government Employee.

I accept the above declaration

Place:

Date: 2012-07-13 14:58:21

Signature of Applicant

Please retain your Registration No. and Password emailed to you carefully for further reference