Application Form Application Number Token Number 1. Exam Details 1.1 Examination 1.2 Post 1.

3 District Head Quarter for 1.4 Medium of Examination 2. Applicant's Details 2.1 Applicant's Full Name 2.2 Applicant's Father Full Name 2.3 Date Of Birth (dd/mm/yyyy) 2.4 Gender 2.5 Marital Status 2.6 Category 2.7 Home State (Bonafide 2.8 Home District : : : : : : : : AMIT KUMAR TIWARI RAKESH TIWARI 09/11/1982 MALE Married General RAJASTHAN KOTA : : : : LECTURER ELECTRONICS ENGINEERING EXAM 2011 LECTURER ELECTRONICS ENGINEERING AJMER English : 54010763392 : 1123007310003812 Application Filled Reference Application : 25/07/2011 12.43 PM : 54010763392

Photo & Signature Of Candidate 3. Other Special Categories 3.1 Category for Disabled 3.2 Specific Category for 3.3 Other Category 4. Correspondence Details 4.1 Address : : :

: Purohit Nagar,Near New railway Colony,H.NO.-34/202,C/O Tiwari Clinic, New Railway Colony,Tehsil : KOTA,City/Village : KOTA - 324002 Dist : KOTA, State : RAJASTHAN

4.2 Email 4.3 Phone 4.4 Mobile 5. Qualification

: tiwari.9.99@gmail.com : 07443205656 : 9887809487

Year

Division/Grade

5.1 Secondary : 1998 5.2 Sr. Secondary : 2000 5.3 Graduation : 2006 5.4 Post Graduation : 6. Additional Qualifications/Specifications 6.1 Other 6.2 Examination passed 6.3 Internship Period 6.4 Experience 7. Identification 7.1 Body Mark 8. Disclaimer : : : From : : Year : 4

1 2 1

Passed

To : Months : 1

Days : 5

: mark on forehead

I hereby declare that all information made in this application are true, complete and correct to the best of my knowledge and belief. In the event of my information being found false or incorrect or the ineligibility being detected before or after the Screening Test/Interview, action can be taken against me by the Commission. I have read the provisions of the relevant rules and the Advertisement carefully and I hereby undertake to abide by them. I further declare that I fulfill all the conditions of eligibility regarding age limits, educational qualification and required experience etc. prescribed for admission to the Screening Test/Interview. Also I accept SMS facility provided by the Commission.

Rajasthan Public Service Commission Ghooghara Ghati, Jaipur Road, Ajmer Phone : +91+145+ 5151200, 5151240 & 5151090

Nodal Officer: Mr. G.S.Tilwani, Asstt. Sect. (0145-5151218)