deZpkjh p;u vk;ksx

STAFF SELECTION COMMISSION

thou o`r fooj.k
BIO-GRAPHICAL DATA
(vkosnd }kjk Lo;a vius vki esa Hkjk tkuk gS)
(To be filled in by the candidate in his/her own handwriting)
Advt. No@foKkiu la0---------------------- Cat.No@Js.kh la0---------------------------ijh{kk dk uke@Name of Examination....................................................

1-

in dk uke
Name of the Post :...............................................................................

2-

uohure ikliksVZ
vkdkj dk iQksVksxzki
Recent Pasport
size Photograph

jksy uEcj
Roll No. : ...............................................................................................

3-

lk{kkRdkj dh rkjh[k@LFkku
Place / Date of Interview......................................................................

4-

uksV % iQksVksxzkiQ fpidkus ds i'pkr d`i;k

ml ij gLrk{kj djsA
N.B.: Please sign your photograph
after affixing

Li"V v{kjksa esa uke (tSlk vkosnu esa fy[kk gks)

Name (In Block Letters) (as written in Application Form) :...........................................................................

............................................................................................................................................................................

5-

fyax@Sex % iq:"k@L=kh (Male/Female)

6-

tUe frfFk@Date of Birth

7-

o"kZ

Day Month

Year

oSokfgd fLFkfr vfookfgr @ fookfgr

Marital Status :

8-

fnol ekl

Un-married / Married

firk@ifr dk uke
Father's / Husband's Name :...........................................................................................................................

9(i)

9(ii)

orZeku irk@ Present Address :

................................................................................................................

LFkk;h irk@Permanent Address

................................................................................................................
................................................................................................................
................................................................................................................
................................................................................................................
................................................................................................................

10(i) ekr`Hkk"kk
Mother tongue :
10(ii) vU; Hkk"kkvksa dh tkudkjh
Other Languages Known

11

................................................................................................................
Read (i<+us esa l{ke)
.................................................... Write (fy[kus esa l{ke)
Speak (cksyus esa l{ke)

fuokl dk jkT;@LFkk;h fuokl

State of Domicile / Permanent Residence...................................................................................................

'kS{kf.kd xfrfof/;k

12 A

RECORD OF EDUCATIONAL QUALIFICATION

ijh{kk@
mikf/ dk uke
(eSfVd lfgr)

la-

cksM@Z
fo'ofo|ky;

Sl.
No.

Name of the
Examination/Degree
(beginning with Matric)

Board/
University

ftl o"kZ
esa mkh.kZ
gq,
Year of
Passing

Js.kh
Class/
Division

vadksa dk
izfr'kr

i<+kbZ dk
ek;e

% of
Marks

Medium of
Instruction

fo"k;@fo'ks"k fo"k;ksa
dk mYys[k djsa

vxj dksbZ fo'ks"k

miyfC;k gks rks
iqjLdkjks@Nk=ko`fRr;ks@a
o`fkdk;ks@othiQs dk
mYys[k djs

Subjects/
Honours or
Spl. Subjects
may be
Mentioned

Outstading Achievements if any mention

Prizes/Scholarships/
Stipends. etc.

dk;ksZkj xfrfof/;ksa dk vfHkys[k

12 B

RECORD OF EXTRA-CURRICULAR ACTIVITIES

gkbZLdwy ls ysdj [ksy&dwn] yfyr dykvksa] ukVdksa] fuca/ ys[ku rFkk vU; esa Hkkx ysus dk C;ksjk (izdkj lfgr)
Detailed information (with Certificate(s) of participation in Games, Sports, Fine Arts, Dramatics, Essay-writing
and other may be furnished from high school onwards.

fdu xfrfof/;ksa esa fgLlk fy;k

Activity pursued

Hkkx ysus dh vof/

Period of
participation

Ldwy] dkyst] jkT;] fo'ofo|ky;

vkfn dk izfrfuf/Ro fd;k x;k

fo'ks"k miyfC/;k vxj gks rks

mYys[k djsa

Represented School, College,

State, University etc.

Outstanding achievements
if any

13 A jk"Vh; dsfMV dksj] jk"Vh; lkekftd lsok] lkekftd dk;Z] ioZrkjksg.k lkSj nwljs lkewfgd dk;Zdykiksa esa Hkkx ysus dk

fooj.k (izek.k lfgr)

Participation in NCC, NSS, Social work, Mountaineering and other group activities (certificate to be shown)

lkewfgd iz;Ruksa dk uke

Name of group activity

13 B

Hkkx ysus dh vof/

Period of
participation

Ldwy @ dkyst @ fo'ofo|ky;

Lrj ij

fo'ks"k miyfC/;k ;fn

dksbZ gks

School, College, University

level

Outstanding achievements
if any

dk;Z vuqHko dk fooj.k] ;fn dksbZ gks (mYVs ekuqlkj esa vFkkZr vU; dk igys vkSj blh izdkj) (izek.k lfgr)
Details of work experience, if any (in reverse chronological order i.e. last one first and so on) (with certificate)

inuke
Designation

vius nkf;Ro dk
laf{kIr fooj.k
Name of Duties in
Brief

laxBu dk uke (irk lfgr)

vof/

fy;k x;k ekfld osru

Name of Organisation
(with address)

Period

Monthly salary drawn

14-

'kkSd@:fp
Hobbies/Interests :

15-

i<+kbZ iwjh djus ds ckn vki D;k dj jgs gSa\

What have you been doing since you completed, Your studies?

16-

dksbZ vU; lac lwpuk] ;fn vH;FkhZ nsuk pkgs\

Any other relevent information if the candidate would like to state

fnukad
Date :

LFkku
Station

vkosnd ds gLrk{kj
Signature of Candidate