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It is extremely Important.
Application Form
Exam Details
Application Number: 1155450
Name of The Candidate: SHIVJEET SNI!A "A##$"TI
Fathers Name: "A##$"TI SNI!A %AN&HA#
!others Name: %H'%ATTI DEVI SNI!A "A##$"TI
"#$: (0)0*)1++1
%&e: (, !ears 0 #ont-s 11 Da.s
#ri&inal 'esidence("omicile )tate: $ttar %ra/es-
*ender: #ale
'eli&ion: Hin/u
Nationality: In/ian
Cate&ory: S&
)ub Cast: &HA#A"
!arital )tatus: No
%ost Applie/ 0or: &ate1or. 2D2 3ca/re4 posts
Preference +: &-o5/i/ar) 6aterman) S5eeper) #ali) &oolie) 7-isti) 'i8tman) &ate1or. D
Preference ,: S5eeper9cum90arras- &ate1or. D
Preference -: r/erl.)%eon)88ice %eon) 0arras- &ate1or. D
Preference .: %rocess Ser:er: &ate1or. D
Preference /: Tube 5ell perator9cum9Electrician &ate1or. D
%resent A//ress
%ddress 0ine +: VI''A;E "A#;HA"HA
%ddress 0ine ,: %ST %$"EDHANI
%ddress 0ine -: DIST %"ATA%;A"H
"istrict: %"ATA%;A"H
)tate: $ttar %ra/es-
Pincode: (,01(4
!obile No: +*(1*0,<44
1mail I": man5animu=i1(>1mail?com
%ermanent A//ress
%ddress 0ine +: VI''A;E "A#;HA"HA
%ddress 0ine ,: %ST %$"EDHANI
%ddress 0ine -: DIST %"ATA%;A"H
"istrict: %"ATA%;A"H
)tate: $ttar %ra/es-
Pincode: (,01(4
!obile No: +*(1*0,<44
1mail I": man5animu=i1(>1mail?com
@uali8.in1 Examination Details
Sr?No Name o8 Exam? %asse/
Name o8 Institution)7oar/
)$ni:ersit.
%asse/
!ear
#ax?
#ar=s
#ar=s
obtaine/
%ercenta1e o8 #ar=s
+. Class 2I 3TT%' P'%"1)4 ,55+ 655 ,./ .5.7-
,.
8unior 4i&h )chool
9Class 2III:
3TT%' P'%"1)4 ,55- 655 ,./ .5.7-
-. 4i&h )chool %004%$%" $#%'" ,55/ 655 ,;. .;
0ee Detail
Fee to be submitted <ide %T! cum "ebit card( Credit card of any ban=( Netban=in& ( Challan 9only
)$I: throu&h the )tate $an= of India website ( cash counter. For Fee deposition> please note down
your application sequence number.It is extremely Important.:
,00
Test &enter %re8erences
Test City +: Varanasi
Test City ,: Alla-aba/
Test City -: 'uc=no5
Test City .: A1ra
Test City /: ;ora=-pur
&it. %re8erences o8 %ostin1
City +: ;-aAiaba/
2ersion 7.55.5+
City ,: 0arru=-aba/
City -: 0aiAaba/
City .: ;on/a
City /: 7areill.
&riminal %rocee/in1s: i8 an.
9+: ?hether any criminal complaint case has
e<er been re&istered a&ainst you@:
No
9,: 4a<e you e<er been tried con<icted or
acquitted by Court of 0aw@:
No
Declaration
I declare that I ha<e read all the terms and conditions mentioned in the ad<ertisement and &eneral instructions for the candidates and I fulfill and abide myself with
conditions &i<en in both the ad<ertisement and &eneral instructions. Further> I hereby declare that the information pro<ided in this application form is true> complete
correct to the best of my =nowled&e and belief. I ha<e not concealed any information. In case> any fact mentioned in the %pplication is found to be wron&(incorrect
any later sta&e> my candidature> selection and appointment may be cancelled.
Candidate )i&nature