Public Service Commission U.P.

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I Declare that I have Read the detailed User Manul & Notification.

Notification Details ( Examination )

1. Advertisement Number : 2. Applied For : 3. Type of Recruitment : 4. Application ID : 5. Candidate Registration No. : 6. Candidate Name : 7. Father's/Husband's Name : 8. Gender - Date of Birth : 9. Domicile of UP / Catgory : 10. Are you Married? 11. Contact No./ Email-ID : 12. Bank Name - Payment Mode : 13. Fees, Transaction ID - Date:

A-8/E-1/2013 Assistant Engineer (General/Special Recruitment) Examination- 2013, GENERAL RECTT. Candidate Personnel Details 200014901000200 90120388234 ASHISH RAJ KUMAR Male - 13/03/1991 Yes / General No 9634446420 / ashishsrijan@gmail.com Bank Transaction Details State Bank Of India - IC Rs. 215.00 , 3289132 - 23/01/2014 Other Details of Candidate

14. Are you Dependent of UP Freedom Fighter? 15.a. Are you UP Ex. Army?

No No
- 0 - 0

15.a.1 Service Duration (Day-Month-Year) : 0 15.a.2 Retirement Date(Date/Month/Year) : _ _ _

15.b Are you ECO/SSCO/CO of Army ?

No 15.b.1 Have you complete 5 year service ? No

15.b.2 Have your services been extended for rehabilitation and no disciplinary action is pending No against you ?

16. Are You Handicap of UP?

No 16.1 Are you Blind Or Have Vision problem? : No 16.2 Are you Deaf or Have hearing problem? : No 16.3 Have you any physical Problem? : No

17. Are You Skilled Player Of UP? : 17.1 Are You Govt./Ex-Govt. State Employee of Uttar Pradesh ?

No No

18. High School & Intermediate Board,Year of passing & Roll Number Details
Sr.No Exam ination Passed 1. High School 2. Interm ediate Board Nam e Year of Passing Roll Num ber

CENTRAL BOARD OF SECONDARY EDUCATION CENTRAL BOARD OF SECONDARY EDUCATION

2006 2008

5190339 5619299

Essential Qualification Details

19. Candidate Essential Qualification Details :

Details :
Sr Qualification No.
1 2 Till last date for submitting the applications, the candidates must possess Degree in any one of the follow ing Branch aw arded by an Institution or University established by law in India.- (1) Civil Engineering. OR (2) Mechanical Engineering. OR (3) Agriculture Engineering. OR (4) Electrical Engineering. The upper age limit in the case of a candidate, w ho is trainee, shall be greater by one year in Irrigation and P.W.D. Deptt..

Acquired
Yes No

19.1 Have you a Diploma/Degree in Engineering : 19.2 Your Opted Engineering Branch Name :
Sr Qualification No.
1

Yes

02 - Civil Engineering ( स वल इं जी नय रं ग) Preferential Qualification Details
Acquired
No

A candidate w ho has (1) served in the Territorial Army for a minimum period of tw o years, or (2) obtained a "B" certificate of N.C.C. shall other things being equal, be given preference in the matter of direct recruitment.

Candidate's Address, Photo Signature Details

20. Address : 20.1. House no./Village : 20.2. Street No./PO : 20.3. City Name : 20.4. State / District Name : 20.5. PIN :

C O CHANDRA SHEKHAR ADVOCATE GANAPAT SAHAI MARG NEAR SADAR BLOCK BASTI Uttar Pradesh / BASTI 272001

21. Photo&Signature↓

I accept the following declaration : Yes
1. I hereby declare that I have read all terms & conditions accroding to the advertisement and I accept it. 2. I hereby declare that all the entires/statements made in this application are true, complete and correct to the best of my knowledge and belief. 3. In the event of any information being found false or incorrect being myself ineligible or not being substantiated by the original documents before or after the selection, the commission can take action against me as per rule incase it is detected that I have mislead UPPSC on any issue then I will solely responsible for all penal consequences thereof.

Current status of application Your application is under processing.
Application Form Submission Date :

24/01/2014 , Time : 19:06:05
Application Form printing Date & Time : [ 24/01/2014 ,19:06:24 ]