Uttarakhand Public Service Commission, Haridwar

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Application Form For Uttarakhand Public Service Commission [ LECTURER GOVT. POLYTECHNIC
RECRUITMENT ] Exam - 2015
YOUR APPLICATION FOR THE EXAM / SELECTION has been SUBMITTED, Follow Instructions given
below / /

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Registration No.

POL150240732

Personal Details /

Name/ :
Gender /

Date of Birth/ :
Father's/Husband's Name/ / :
Mother's Name/ :
Nationality /
Domicile Of Uttrakhand /
:
Address/ :

Phone No. with STD Code/

:
Mobile No. /
:
E-Mail /
:
Category Details /

SIDDHARTH KUMAR RAI

Male
26-03-1991
ARUN KUMAR RAI
RANJANA RAI
Citizen Of India
NO
D 113 NTPC COLONY
VIDYUT NAGAR
DADRI
GAUTAM BUDDH NAGAR-201008
0120-2671760
9971499376
siddharthrai2007@gmail.com

Physically Handicapped /

Reservation / :
[(Category / Sub Category) / (
/
)]
Certificate of the Claimed Category/Sub Category :

NO
GEN
No Domicile

Posts Applied /
:

02.

B.E./B.Tech. Electrical Engineering

Essential Educational Qualification /

Exam

Board/University

High
School/Higher
Secondary

CBSE

Intermediate

CBSE

Year

Subject

Marks Obt. / % Marks

Total Marks /
Grade

2006

SCIENCE,ENGLISH,MA THS,SOCIA L
STUDIES,SA NSKRIT

396/500/1

79.2

2008

PHYSICS,CHEMISTRY,MA THS,ENGLISH,PHYSIC
377/500/1
A L EDUCA TION

75.4

B.Tech/B.E./B.Sc./B.A./Graduation
GA UTA M BUDDH

TECHNICA L UNIVERSITY 2012

ELECTRICA L ENGINEERING

Date Of Acquiring Essential Educational Qualification :

Preferential Education Qualification:
1.

Do you have the Certificate of the Claimed Preferential
Qualification

23-09-2012

Yes

Other Details

Are you Employee Of Any (State Govt./Govt. Of

India/Semi Govt.) :

No

Candidate Picture and Signature

Examination Centre / :
Fee Remission Claimed /

Claiming age relaxation /

Experience(If any) /
( ) :

Haridwar
No
No

3437/5000/1 68.74

No. Of Enclosures /
:
Have you ever debar from UPSC or any State PSC,If Yes
then provide the reason and duration./

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:

___________(Manually filled by the candidate

on printout)
No

Declaration /
1.
/

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!
2. , /

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3. , /
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_____________


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Instructions /

Note 1: Take the printout of the completed application form and the copy of chalan.
Note 2: Candidate must deposit the fee by chalan at any of the SBI branch.
Note 3: Candidate must keep himself/herself a copy of complete applicaton form and chalan,
Which will be required for further reference to UKPSC.
/Print
. . .

/ SBI Printed Bank Pay-In Slip

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