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Registration # : 5081072

Full Name :


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 : Religion : Candidate's Place of Birth : Native District : Father's Name : Father's Place of Birth : Mother Tongue : Mother's Name : Communal Category : Name of the SubCaste : Certificate No : Date Of Issue : Issuing Authority : Taluk : District : Address for Correspondence :

12312532 Group I NA NO NO --NO Indian

Net Banking 75.00

14/01/1991 MALE No Christian THANJAVUR Thanjavur DDA DANIEL Nagapattinam Tamil J STELLA Backward Class(BC) SOZHIAVELLALA 4711345 09/11/1994 Zonal Deputy Tahsildar Orathanadu Thanjavur MIG 469, NETHAJI NAGAR NEW HOUSING UNIT

District State : Pin : Permanent Address :

Thanjavur Tamil Nadu 613005 MIG 469, NETHAJI NAGAR NEW HOUSING UNIT

District State : Pin :

Thanjavur Tamil Nadu 613005

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 Physical Standards for per notification : Name of the Examination Centre : Compulsory Subject : Do you claim Age Concession? : Do You Claim Fee Exemption? : Any Degree -P025511 2012 SASTRA UNIVERSITY No Yes Chennai General Knowledge No No 1.Deputy Collector (Code No.1001) 2.Deputy Superintendent of Police (Category I) (Code No.1002) 3.Assistant Commissioner (CT) (Code No.1003) 4.District Employment Officer (Code No.1007) Not Applicable Not Applicable Year of Passing 2006 2008 2012 Medium of Instruction English English English N/A N/A others -hsc N/A N/A MECHANICAL ENGINEERING Degree Major Subject 9790669825

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 Designation



Nature of Duty

Register No.





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.

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


Date: 2013-01-06 16:13:00

Signature of Applicant

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