TamilNaduPublicServiceCommission

&

Name o f th e P o st Ap p l yi n g fo r /  :

VIL L AGE ADMINIST RAT IVE OFFICE RINT HE T AMIL NADU

MINIST E RIAL SE RVICE

No ti fi c ati o n No . / : 1 9 / 2 0 1 5
Ap p l i c ati o n No . / : 5 1 9 0 6 1 2 3 9
Reg i strati o n Date :/ : 1 5 1 1 2 0 1 5 1 3 :0 0 :2 9

Name o f th e Can d i d ate/ :

In i ti al s

Name

KART HIK

Gen d er/ : MAL E

Date o f Bi rth / : 1 2 0 6 1 9 8 6

Fath er' s Name/ :

Mo th er' s Name/ :

In i ti al s

Name

SHANMUGARAJ

In i ti al s

Name

MAL L IGA

Mari tal S tatu s/ ? MARRIE D

S p o u se' s Name/ / : MUT HUKAL ADE VI
Can d i d ate' s P l ac e o f Bi rth / : RAMANAT HAPURAM
Nati ve Di stri c t/ : RAMANAT HAPURAM
Fath er' s P l ac e o f Bi rth / : RAMANAT HAPURAM
Mo th er To n g u e/ : T AMIL
Nati o n al i ty/ : INDIAN
Rel i g i o n / : HINDU

CertificateDetails /
Co mmu n al Categ o ry/  : DE NOT IFIE DCOMMUNIT Y(DC)
Name o f th e S u b Caste/
:

Certi fi c ate No / :

711506

Date o f Issu e/ :

3 0 0 5 2 0 0 3

Issu i n g Au th o ri ty/
:

Z ONAL DE PUT Y
T AHSIL DAR

Di stri c t/ :

RAMANAT HAPURAM

Tal u k/ :

RAMANAT HAPURAM

Are yo u a Di fferen tl y Ab l ed P erso n / R ? NO

Are yo u a Go vern men t E mp l o yee/ & ? NO
Have yo u b een d eb arred o r d i sq u al i fi ed b y th e P u b l i c S ervi c e
Co mmi ssi o n o r an y o th er rec ru i ti n g ag en c y fro m ap p eari n g
exami n ati o n s an d sel ec ti o n s fo r sp ec i fi c p eri o d o r p erman en tl y? /
H R
R H U H

MARAVARS

NO

H 
H ?

Are yo u an E xS ervi c emen / D ? NO

Cri mi n al Case Reg i stered /   ? NO
P arti c i p ati o n i n P o l i ti c al Ac ti vi ti es / ? NO

CommunicationDetails / 

Co rresp o n d en c e Ad d ress/

P erman en t Ad d ress/
Ad d ress Li n e 1 / 1 : 1 / 9 5 MSKSNAGAR

Ad d ress Li n e 1 / 1 : 1 / 9 5 MSKSNAGAR

Ad d ress Li n e 2 / 2 : VE L IPAT T INAMPOST

Ad d ress Li n e 2 / 2 : VE L IPAT T INAMPOST

Ad d ress Li n e 3 / 3 :

Ad d ress Li n e 3 / 3 : RAMANAT HAPURAMDIST RICT

S tate/ : T AMIL NADU

RAMANAT HAPURAM
DIST RICT

S tate/ : T AMIL NADU

Di stri c t/ : RAMANAT HAPURAM

Di stri c t/ : RAMANAT HAPURAM

P i n c o d e/ 
: 6 2 3 5 0 4

P i n c o d e/ 
: 6 2 3 5 0 4

E mai l ID/ : ka rthi ksha nmug a ra j@g ma i l .co m

Mo b i l e No / : 7 7 0 8 6 0 6 2 4 4

EducationalQualificationParticulars / 
S S LC
Date o f Resu l t P u b l i sh ed / 5 :

2 2 0 5 2 0 0 1

Name o f th e Bo ard / Un i versi ty /  / :

ST AT E B OARD

Certi fi c ate Nu mb er/ :

1045624

Wh eth er stu d i ed Tami l as o n e o f th e su b jec t/ H

R
?

Med i u m o f In stru c ti o n / R :

YE S
T AMIL

S el ec t th e evi d en c e fo r P erso n s S tu d i ed i n Tami l Med i u m ( P S TM) wi th a rec o rd i n g

th at h e/ sh e stu d i ed th e P resc ri b ed o rE q u i val en t Qu al i fi c ati o n i n Tami l Med i u m /
R H

MARKSHE E T

 (Tam ilM e dium ) H

:

Certi fi c ate o f E vi d en c e fo r P S TM i ssu ed o n / :

1 8 0 6 2 0 0 1

Certi fi c ate o f E vi d en c e fo r P S TM i ssu ed b y ( Issu i n g au th o ri ty) /

SE CRE T ARYB OARDOFSE CONDARYE DUCAT ION

T AMIL NADU

HS C
Date o f Resu l t P u b l i sh ed / 5 :

0 7 0 5 2 0 0 3

Med i u m o f In stru c ti o n / R :

T AMIL

Name o f th e Bo ard / Un i versi ty /  / :

ST AT E B OARD

Certi fi c ate Nu mb er/ :

0042890

Wh eth er stu d i ed Tami l as o n e o f th e su b jec t/ H

R
?

YE S

U n d erGrad u ate
Date o f Resu l t P u b l i sh ed / 5 :

1 5 0 6 2 0 0 7

Name o f th e Deg ree / 5 :

B ACHE L OROFE NGINE E RINGB .E

Majo r S u b jec t/

E L E CT RICAL ANDE L E CT RONICS

Name o f th e Bo ard / Un i versi ty /  / :

ANNAUNIVE RSIT YCHE NNAI

Certi fi c ate Nu mb er/ :

92103105014

Wh eth er stu d i ed Tami l as o n e o f th e su b jec t/ H

R
?

Med i u m o f In stru c ti o n / R :

NO
E NGL ISH

ExperienceDetails / 
Name o f th e Org an i sati o n ( s) /
R

Desi g n ati o n /

P eri o d Fro m/

P eri o d To /

Natu re o f Du ty/

T NE B

GRAUDAT E
APPRE NT ICE
T RAINE E

0 5 0 9 2 0 0 8

0 5 1 2 2 0 0 8

T RAINE E

PE T ROSE RVL IMIT E D

E ST IMAT ION
E NGINE E R

1 7 1 2 2 0 0 8

1 5 1 1 2 0 1 5

E NGINE E R

Do yo u h ave th e P h ysi c al S tan d ard s as p er n o ti fi c ati o n ? /

  R
? :

YE S

ExaminationParticulars /
Name o f th e E xami n ati o n Cen tre/ : AL ANDUR
S u b jec t( s) fo r E xami n ati o n / :

GE NE RAL ST UDIE SWIT HB ASICSOFVIL L AGE ADMN.AND

GE NE RAL E NGL ISH(SSL CST D.)

RegistrationFees
* P aymen t Mo d e ONL INE T RANSACT IONID:IK9 5 1 9 9 9 9 1 FE E SAMOUNT :7 5

FeeConcession /
** Do yo u c l ai m exami n ati o n fee c o n c essi o n ? /

? :

NO

Declaration / R
I h ereb y d ec l are th at al l th e p arti c u l ars fu rn i sh ed i n th i s ap p l i c ati o n are tru e, c o rrec t an d c o mp l ete to th e b est o f my kn o wl ed g e an d b el i ef.
In th e even t o f an y i n fo rmati o n b ei n g fo u n d fal se o r i n c o rrec t o r i n el i g i b i l i ty b ei n g d etec ted b efo re o r after th e exami n ati o n , ac ti o n c an b e
taken ag ai n st me b y th e TNP S C.
 H  5 H, H R H .
 H R H  H H 

H 5  .

I h ereb y d ec l are th at I wi l l n o t b e a p arty to an y ki n d o f c an vassi n g o n my b eh al f.

.

I fu rth er d ec l are th at I fu l fi l al l th e el i g i b i l i ty c o n d i ti o n s p resc ri b ed fo r ad mi ssi o n to th e exami n ati o n .

 H  R R R .

I h ave g o n e th ro u g h th e i n stru c ti o n s to th e c an d i d ates an d th e Co mmi ssi o n ' s n o ti fi c ati o n fo r th i s Rec ru i tmen t b efo re fi l l i n g u p th e
ap p l i c ati o n fo rm.
" U " R
5H K H .

I d ec l are th at I p o ssess th e P h ysi c al stan d ard s p resc ri b ed fo r th e p o st( s) wh i c h I am n o w ap p l yi n g .

 H U   R R R .

I Certi fy th at I h ave n o t b een d eb arred / d i sq u al i fi ed b y th e TNP S C o r an y o th er rec ru i ti n g ag en c y.

H R H 

.

I am n o t a d i smi ssed Go vern men t E mp l o yee.

& .

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