UttarPradeshSubordinateServicesSelectionCommission,Lucknow



,
IDeclarethatihaveReadthedetailedUserManul&Notification.

NotificationDetails(DirectRecruitment)

Advertisement
Number:

18(5)/2016

AppliedFor:

Typeof
Recruitment:

General

Director,
Technical
Education,Uttar
Pradesh,Kanpur./
Workshop
InstructorSheet
MetalPainting
GovtPolytechnic,

Candidate'sPersonalDetails

Application
ID:
Candidate
Name:
Gender
Dateof
Birth:
Areyou
Married?

200003525000085 RegistrationNo.: 52500040361

VIJAY
Father's/Husband's
SHIVLOCHANPAL
BAHADURPAL Name:
Male08/08/1994

DomicileofUP/
Category:

Yes/SC

Yes

ContactNo./
EmailID:

9935672472
/vijay080894@gmail.com

BankTransactionDetails

BankName
PaymentMode:

StateBankOf
IndiaSTATE
BANKINB

Rs.25.00,
Fees,Transaction
DU54622941
IDDate:
02/10/2016

OtherDetailsofCandidate

AreyouDependentofUP
FreedomFighter?

No

ServiceDuration(Day
MonthYear):

0
0
0

AreyouUPEx.Army?

No

Retirement
Date(Date/Month/Year):

___

AreyouECO/SSCO/COof No
Army?

Haveyoucomplete5year
No
service?

Haveyourservicesbeen
extendedforrehabilitation
No
andnodisciplinaryactionis
pendingagainstyou?
CompletionDateof
Debarment
../../....
(DD/MM/YYYY):
AreyouBlindOrHave
No
Visionproblem?:

Haveyoueverbeen
DebarredfromU.P.
SubordinateServices
SelectionCommission?:

No

AreYouHandicapofUP?

Yes

AreyouDeaforHave
hearingproblem?:

No

Haveyouanyphysical
Problem?:
Sr.
No.

Yes

PHCategory[LOCOMOTORor
CEREBRALPLASY]

16.3.1 BothLegsaffectedbutnotarms[BL]

SelectedPHCategory
BL

16.3.2 BothArmsaffected[BA]

BA

16.3.3 BothLegsandBothArmsaffected[BLA]

BLA
OLYes

16.3.4 OneLegaffected(rightorleft)[OL]

ImpairedReach
grip

16.3.5 OneArmaffected(rightorleft)[OA]
SiffBackandHips(Cannotsitorstoop)[
BH]
MuscularWeaknessandlimitedphysical
16.3.7
endurance[MW]
No

AreYouGovt./ExGovt.
StateEmployeeofUttar
Pradesh?

No

Ataxic

OA

16.3.6

AreYouSkilledPlayerOf
UP?:

Weaknessof

BH
MW

HighSchool&IntermediateBoard,Yearofpassing&RollNumberDetails

Sr.No Examination BoardName

Passed
1.
HighSchool UTTARPRADESH

Yearof Roll
Obtained Total
Passing Number Marks Marks
2008

1532505

387

600

2.

N/A

N/A

N/A

N/A

BOARDOFHIGH
SCHOOLAND
INTERMEDIATE
EDUCATION
Intermediate N/A

EssentialQualificationDetails

Is
Obtain Total Percentage
Acquired Grade
Marks Marks (%)
System

Sr
Qualification
No.

1
2

3YearcertificateintheconcernedTradefrom
GSTSorHighSchoolwithcertificateinthe
concernedTradeofITIGITIPolytechnicor
Diplomainrespectivebranch.
3Yearpostcertificateindustrialexperience.

Yes

No

1538.002200.0069.91

Yes

N/A

N/A

N/A

N/A

PreferentialQualificationDetails

Sr
Qualification
Acquired
No.
Acandidatewhohas(1)ServedintheTerritorialArmyforaminimumperiodoftwo
1 yearsor(2)ObtainedBcertificateofNationalCadetCorpsshallotherthingsbeingequal No
begivenpreferenceinthematterofdirectrecruitment.
Candidate'sAddress,PhotoSignatureDetails

Address
Details

Candidate's
Permanent
Address

Candidate's
Correspondence/Mailing
Address

Address
/Name:

VIJAY
VIJAYBAHADUR
BAHADURPAL PAL

Photo&Signature

House
CHAUKTHA
no./Village NARVAR
:
Street
No./PO:

AUNTA

CHAUKTHA
NARVAR
AUNTA

CityName
ALLAHABAD
:

ALLAHABAD

State/
District
Name:

UttarPradesh/
ALLAHABAD

UttarPradesh/
ALLAHABAD

PIN:

212303

212303

Iacceptthefollowing
Yes
declaration:

1.IherebydeclarethatIhavereadallterm&conditionaccrodingadvertisementandIacceptit.
2.Iherebydeclarethatalltheentires/statementsmadeinthisapplicationaretrue,completeandcorrect
tothebestofmyknowledgeandbelief.
3.Intheeventofanyinformationbeingfoundfalseorincorrectorineligibilitybeingdetectbeforeor
afterSelection,thecommissioncantakeactionagainstmeasperruleincaseitisdetectedthatIhave
misledUPSSSConanyissuethenIwillsolelyresponsibleforallpenelconsequencesthereof.

Currentstatusofapplication
Yourapplicationisunderprocessing.
ApplicationFormSubmissionDate: 04/10/2016,Time:3:23:10PM
ApplicationFormprintingDate&Time:[04/10/2016,3:17:35PM]