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APPLICATION FORM FOR SUPPORTING ASSISTANT

PERSONAL DETAILS
1. Registration Number : 2. Preferred Place of Posting : 3. Name of the Applicant : 4. Fathers name : 2549527286 Nagaon JAYEETA DEY MILAN CHANDRA DEY

5. Mothers name :

SHIPRA RANI DEY

6. Date of birth :

05-10-1990

7. Age as on date of Advt. :

23 YEARS

8. Gender : 9. Domicile State : 10. Nationality : 11. Mother Tongue : 12. Category [Gen/OBC/MOBC/SC/ST(P) /ST(H)/PWD] : 13. Marital Status : 14. Spouse Name :

Female ASSAM INDIAN BENGALI GENERAL Unmarried NA HSLC SEBA 2006 SECOND DIV HS AHSEC 2008 SECOND DIV BBA SIKKIM MANIPAL UNIVERSITY 2011 SECOND DIV BCOM GUWAHATI UNIVERSITY 2012 SECOND DIV MS OFFICE TALLY NA

15. Educational Qulaifications:

16. Other Qualifications/Technical Qualifications: 17. Work Experience:

CONTACT DETAILS
18.Address :

Permanent
HARULONG PHAR LAST COLONY LUMDING DIST NAGAON PIN 782447 ASSAM 19. Phone Number: 20. Email Id: 21. If any FIR/Complain/Criminal case pending against you in any Police Station/Court : 22. Whether the applicant was convictyed of an Offence: 9508113090 jayeeta.dey20008@gmail.com NA

Correspondence
HARULONG PHAR LAST COLONY LUMDING DIST NAGAON PIN 782447 ASSAM

NA

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23. Whether the applicant was debarred from appearing in any examination due to unfair means: 24. Whether the applicant is an Income Tax Assessee: 25. Bank Transaction ID/Journal No.

No

NA 026351774

Declaration:- I have read the advertisement carefully and I agree to all the terms and conditions. I do hereby declare that the information given in this application form is correct and true to the best of my knowledge and if any information furnished above is found to be false/incorrect, I shall be solely responsible for the same and authority can take suitable disciplinary/legal action against me.

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