Application Form Application Number Token / Transaction : 100150203531682 : 1321030310049859 : : : : Payment Mode : E-Mitra Application Filled Date Reference

Application : 16/09/2013 3:19 PM : 100150203531682

1. Exam Details 1.1 Examination Name 1.2 Examination Post 1.3 District Head Quarter for Exam 1.4 General Subjects (PRE) 1.5 Optional Subjects (PRE) 1.6 General Subjects (MAINS) 1.7 Optional Subjects (MAINS) 1.8 Number Of Attempts 1.9 Medium Of Exam 2. Department Preferences 2.1 Department Preference 3. Applicant's Details 3.1 Applicant's Full Name 3.2 Applicant's Father Full Name 3.3 Applicant's Mother Full Name 3.4 Date Of Birth (dd/mm/yyyy) 3.5 Gender 3.6 Marital Status 3.7 Category 3.8 Home State (Bonafide Resident) 3.9 Home District

SR TEACHER GRADE II COMP EXAM 2013 ENGLISH AJMER PAPER-I

: ENGLISH : : :1 : English :

: : : : : : : : :

JAYA SHUKLA SHRI PRADEEP PAL SHUKLA MANJU SHUKLA 30/04/1986 FEMALE Married General/OBC( Creamy Layer ) RAJASTHAN AJMER Photo & Signature Of Candidate

4. Other Special Categories 4.1 Category for Disabled Candidates 4.2 Specific Category for Female 4.3 Other Category 5. Correspondence Details 5.1 Address

: : :

: 26/376, PATHAR WALI GALI RAMGANJ AJMER, RAMGANJ ,Tehsil : AJMER,City/Village : AJMER - 305001 Dist : AJMER, State : RAJASTHAN : jayashukla15@yahoo.com : 01452691674 : 9461475132
Year Division/Grade

5.2 Email 5.3 Phone 5.4 Mobile 6. Qualification 6.1 Secondary 6.2 Sr. Secondary 6.3 Graduation 6.4 Post Graduation 7. Additional Qualifications/Specifications 7.1 Other Specification/Qualification 7.2 Examination passed 7.3 Internship Period 7.4 Experience 8. Identification 8.1 Body Mark 9. Disclaimer

: : : : :

2001 2003 2006 2010

Second First Second Second

Passed Passed

: B.Ed. or equivalent : From : To : Months : : Days : : MOLE ON RIGHT CHIN

Year : 3

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. Akhilesh Mittal, System Analyst (Joint Director) Help Line : 0145-5151212