9/24/2019 Andhra Pradesh Grama/Ward Sachivalayam

Personal Details

VSWS HallTicket Number 191006000875

Applicant Name BARATAM RENUKA

Post Applied Village Agriculture Assistant (Grade-II)

Date Of Birth of Applicant 03/08/1993

Mobile 9701652798

Religion HINDU

Community BC-D

Community Sub Caste Kalinga Koma / Kalinga Vysya

Place Of Birth PEDDAPADU SRIKAKULAM

District To Which Belong SRIKAKULAM

Mar al Status UNMARRIED

Present District SRIKAKULAM

Present Address 1-341,PEDDAVEEDHI,PEDDAPADU,SRIKAKULAM,532401

Permanent District SRIKAKULAM

Permanent Address 1-341,PEDDAVEEDHI,PEDDAPADU,SRIKAKULAM,532401

PRECEEDING RESIDENTIAL DETAILS

From To
Sl.No Residential Address Police Station & District
Month/Year Month/Year

1- SRIKAKULAM RURAL POLICE

1 09/2018 09/2019
341,PEDDAVEEDHI,PEDDAPADU,SRIKAKULAM,ANDHRAPRADESH STATION

1- SRIKAKULAM RURAL POLICE

2 09/2017 09/2018
341,PEDDAVEEDHI,PEDDAPADU,SRIKAKULAM,ANDHRAPRADESH STATION

1- SRIKAKULAM RURAL POLICE

3 09/2016 09/2017
341,PEDDAVEEDHI,PEDDAPADU,SRIKAKULAM,ANDHRAPRADESH STATION

1- SRIKAKULAM RURAL POLICE

4 09/2015 09/2016
341,PEDDAVEEDHI,PEDDAPADU,SRIKAKULAM,ANDHRAPRADESH STATION

1- SRIKAKULAM RURAL POLICE

5 09/2014 09/2015
341,PEDDAVEEDHI,PEDDAPADU,SRIKAKULAM,ANDHRAPRADESH STATION

Father Details

Father Name BARATAM RAGHAVA RAO

Profession/Job No

Postal District SRIKAKULAM

Postal Address 1-341,PEDDAVEEDHI,PEDDAPADU,SRIKAKULAM,532401

Permanent District SRIKAKULAM

Permanent Address 1-341,PEDDAVEEDHI,PEDDAPADU,SRIKAKULAM,532401

EDUCATION QUALIFICATION DETAILS

Examination
Entering Leaving RegNo & Police Station &
Course Name Of School/College Address
Date Date Passed District
Details

SSC/Matriculation GOVT GIRLS HIGH SCHOOL,SRIKAKULAM 04/2007 03/2008 SSC SRIKAKULAM RUARAL

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9/24/2019 Andhra Pradesh Grama/Ward Sachivalayam

EDUCATION QUALIFICATION DETAILS

Examination
Entering Leaving RegNo & Police Station &
Course Name Of School/College Address
Date Date Passed District
Details

Intermediate/Diploma GAYATRI JUNIOR COLLEGE,MUNASABPETA,SRIKAKULAM 04/2008 03/2010 BIPC SRIKAKULAM RURAL

BSC
COMMERCIAL
RAJENDRANAGAR
Graduation/Professional ACHARYA N G RANGA AGICULTURAL AGRICULTURE
04/2010 04/2014 POLICCE
Course UNIVERSITY,RAJENDRANAGAR,RANGAREDDY,HYDERABAD AND
STATION,RANGAREDDY
BUSINESS
MANAGEMENT

Post Graduation --- --- --- --- ---

Any other Qualification --- --- --- --- ---

Case Details

Is Arreted By Police.convicted by Court Of Law Under any

No
state/central Laws

Have you ever been arrested No

Have you ever been prosecuted No

Have you ever been kept under deten on No

Have you ever been bound down No

Have you ever been fined by a Court of Law No

Have you ever been convicted by a court of Law No

Have you ever been debarred from any examina on or rus cated by
No
any university or any other educa onal authority/ins tu on

Have you ever been debarred /disqualified by any Public Service

Commission/Staff Selec on Commission/or any other recruitment No
board for any of its examina on/selec on

Is any case pending against you in any court of law at

No
the me of filling up this Antecedents form

Is any case pending against you in any University or other educa onal
No
authority/ins tu on/ at the me of filling of this Antecedents Form?

Whether discharged/expelled/with drawn from any

training/ins tu on under No
the Government or otherwise?

RESPONSIBLE PERSON DETAILS

First Preference Second Preference

Name in Full Sur Name BARATAM RAGHAVA RAO BARATAM KRISHNA VENI

Given Name If Any -- --

Fathers Name BARATAM SEETHARAMAIAH VARANASI MUSALAYYA

House/Apart/Flat No 1-341 1-341

Street and Road PEDDAVEEDHI PEDDAVEEDHI

Village PEDDAPADU PEDDAPADU

Mandal/Taluk SRIKAKULAM SRIKAKULAM

Town/City ALIKAM ALIKAM

District SRIKAKULAM SRIKAKULAM

Pin Code 532401 532401

Urban/Rural RURAL RURAL

DECLARATION DETAILS

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DECLARATION DETAILS
1. I hereby declare that the statements made In this form are true to the best of my knowledge and belief.
2. I am married / unmarried and have only one wife living ( delete which Is not applicable).
3. I am fully aware that furnishing of false Information or suppression of any factual Information in the Antecedents Form
would be a disqualfication and is likely to render me unfit for employment under the Government.
4. I am also fully aware that If It comes to notice at any time during my service that false Information has been furnished or
that there has been suppression of factual Information in the Antecedents Form, my services would be liable to be terminated
solely on this ground.
Date Signature of the Candidate
Place (Full Name: )

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