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This online application is provisional subject to payment of application fees/ intimation charges

Registration # : 390898443

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 Sub Caste : Certificate No : Date Of Issue : Issuing Authority : Taluk : District : Address for Correspondence :

11773555 Group-IV Services NA NO NO --NO Indian

Post Office 75.00

06/04/1990 MALE No Hindu VELLORE GOVT HOSPITAL Salem T RAMALINGAM Salem Tamil K KALAICHELVI Backward Class(BC) Viswakarma 3443829 10/04/1991 Zonal Deputy Tahsildar Hosur Krishnagiri 1-370, EZHIL NAGAR BEGAPALLI(VI & PO),SIPCOT HOSUR

District State : Pin : Permanent Address :

Krishnagiri Tamil Nadu 635126 1-370, EZHIL NAGAR BEGAPALLI(VI & PO),SIPCOT HOSUR



State : Pin : Contact Details : Email ID : Mobile No : EDUCATIONAL QUALIFICATION PARTICULARS : Exam Passed Year of Publication of Result S.S.L.C : H.S.C : Degree : Others : Do you claim reservation for Persons Studied in Tamil Medium (PSTM)? : Are you trained person in Survey in ITI, Tamil Nadu? (Eligible for Field Surveyor and Draughtsman post only)? : 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 : SSLC -146954 2005 Maharishi Vidya Mandir No English Type Writing Short hand Computer Qualification (for Typist and Steno-Typist, Grade III) ? Do you possess Certificate Course in Computer on Office Automation awarded by the Technical Education Department? : Preferential Physical Standards for per notification : Do you claim reservation for Persons Studied in Tamil Medium (PSTM)? : Name of the Examination Centre District: Name of the Examination Centre : Optional Subject (As per Notification) : Do you claim Age Concession? : Do You Claim Fee Exemption? : -Cert. No. Issued by Dir. of Cert. No. Issued by Dir. Tamil Technical Education of Technical Education ---2005 2007 2011 English English English N/A N/A B.TECH. -No No N/A N/A INFORMATION TECHNOLOGY CBSE State board BHARATH UNIVERSITY Medium of Instruction Degree Major Subject Board / University 9894480743 Tamil Nadu 635126

Type writing / Short hand Qualification





No Yes No Chennai-South Velachery General Studies with General English (S.S.L.C Standard) No No 1.Junior Assistant (Security) (Post Code 2400) 2.Field Surveyor (Post Code 2800) 3.Draftsman (Post Code 2900) 4.Junior Assistant (Non-Security) (Post Code 2600) 5.Bill Collector, Grade-I (Post Code 2500) 6.Typist (Post Code 2200) ,7.Steno-Typist, Grade III (Post Code 2300) Not Applicable Not Applicable

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: 2013-07-02 19:43:32

Signature of Applicant

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