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Application Form Draft Print For All
Application Form Draft Print For All
APPLICATION IS INCOMPLETE
1. NAME AS PER 2. NEW/ CHANGED 3. FATHER'S NAME 4. MOTHER'S NAME
MATRICULATION CERTIFICATE NAME
MANISH KUMAR - DAYANAND KUMAR ROSHNI
6. AGE AS ON
5. DATE OF BIRTH (DD/MM/YYYY) 7. GENDER 8. CATEGORY
01/01/2020
15/03/2000 19.9 MALE OBC
9. WHETHER PERSON WITH DISABILITY (PWD) ? 9.1 IF YES, TYPE OF DISABILITY (OH, HH,VH, OTHERS)
NO -
NO - -
19.3. DATE OF JOINING THE CIVIL POST (DD/MM/YYYY) 19.4. LENGTH OF SERVICE IN ARMED FORCES (IN YEARS)
- -
20.1. WHETHER SUFFERING FROM CEREBRAL-PALSY ?
-
20.2. DO YOU HAVE A PHYSICAL LIMITATION TO WRITE AND SCRIBE IS REQUIRED TO WRITE ON YOUR BEHALF
(CERTIFICATE TO THIS EFFECT FROM THE CHIEF MEDICAL OFFICER/ CIVIL SURGEON & MEDICAL
SUPERINTENDENT OF A GOVERNMENT HEALTH CARE INSTITUTION AS PER NOTICE OF THE EXAMINATION
WOULD BE REQUIRED AT THE TIME OF EXAMINATION) ?
-
20.3. WHETHER SCRIBE IS REQUIRED ? 20.4. WILL YOU 20.5. IF SCRIBE IS TO BE ARRANGED BY SSC, INDICATE
MAKE YOUR MEDIUM
OWN
ARRANGEMENT
OF SCRIBE ?
- - -
21. WHETHER SEEKING AGE RELAXATION ? 21.1 IF YES, AGE RELAXATION CODE
NO
-
23. DO YOU WANT TO MAKE AVAILABLE YOUR
PERSONAL INFORMATION FOR ACCESSING JOB
22. QUALIFICATION DETAILS OPPORTUNITY IN TERMS OF DoP&T'S O.M
NO.39020/1/2016-ESTT.(B) DATED 21.06.2016 ?
ADDRESS DETAIL
24. CORRESPONDENCE ADDRESS 25. PERMANENT ADDRESS
T-33F RAILWAY COLONY DELHI CANTT NEAR DELHI WARD NO 13 DHANI TIVADIVALI MANDANA BABAI
CANTT RAILWAY STATION
DISTRICT: SOUTH WEST DELHI DISTRICT:JHUNJHUNU
STATE: DELHI STATE: RAJASTHAN
PIN : 110010 PIN : 333501
MOBILE NO: 9650314470 EMAIL: man13092000@gmail.com
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
NOT EXEMPTED 100 - -
DECLARATION
1. I HAVE READ THE NOTICE OF EXAMINATION AND ACCEPT ALL THE TERMS & CONDITIONS
MENTIONED THEREIN.
2. I HEREBY DECLARE THAT ALL STATEMENTS MADE IN THIS APPLICATION ARE TRUE, COMPLETE
AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT IN THE EVENT OF
ANY INFORMATION BEING FOUND SUPPRESSED/FALSE OR INCORRECT OR INELIGIBILITY BEING
DETECTED BEFORE OR AFTER THE EXAMINATION, MY CANDIDATURE/ APPOINTMENT IS LIABLE TO BE
CANCELLED.I AM WILLING TO SERVE ANYWHERE IN INDIA.
PRINT TAKEN ON: 04/12/2019 12:34:04 PM