GOVERNMENT OF ASSAM

STATE LEVEL POLICE RECRUITMENT BOARD, ASSAM

REHABARI::: GUWAHATI

(NO APPLICATION FEE IS APPLICABLE)

APPLICATION FORM

ADVT NO: SLPRB/ REC/JA-STENO/2018/159 APPLY DATE: 13-MAY-2020

APPLICATION NO. NAME: DATE OF BIRTH:

JRA1969 KAILASH NATH 08-01-1996

FATHERS' NAME: MOTHERS' NAME: CASTE:

KAMAL NATH REKHA NATH OBC/MOBC

EMAIL: PHONE: ADD. PHONE: GENDER:

NATHKAILASH842@GMAIL.COM 8136053669 NA MALE

NATIONALITY: RELIGION: EMPLOYMENT NO. :

INDIAN HINDU NA

POST APPLIED FOR :

JUNIOR ASSISTANT DISTRICT LEVEL (PREFERENCE 1)
JUNIOR ASSISTANT ASSAM POLICE HEAD QUARTERS (PREFERENCE 2)

PERMANENT ADDRESS CORRESPONDENCE ADDRESS

JATAKIA NATH GAON ,SIVASAGAR ,ASSAM JATAKIA NATH GAON ,SIVASAGAR ,ASSAM

DISTRICT: POLICE STATION: PIN: DISTRICT: POLIOCE STATION: PIN:

SIVASAGAR NAZIRA 785666 SIVASAGAR NAZIRA 785666

ACAMEDIC QUALIFICATION: EXTRA CURRICULAR ACTIVITIES:

STENOGRAPGY
COLLEGE NAME: COMPUTER CERTIFICATE
CERTIFICATE
SIBASAGAR COLLEGE, JOYSAGAR YES
NA

QUALIFICATION: DEPARTMENT: PERCENTAGE: EWS CERTIFICATE

GRADUATE SCIENCE 65.5 % NA

DECLARATION:
It is certified that above particulars are true to my knowledge and belief. Further, I understand that if any of the above particulars is found false, my candidature will
be automatically rejected.

NOTICE:
Candidate should check all the data entered in the application form very carefully. Any issue noticed, candidate may contact recruitment Help Desk Tel: 7636071991, 7636071992, 7636071993 (09:00am -
06:00pm) or Email: slprbrect@gmail.com.