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GOVERNMENT OF ASSAM

STATE LEVEL POLICE RECRUITMENT BOARD, ASSAM


REHABARI::: GUWAHATI

(NO APPLICATION FEE IS APPLICABLE)

APPLICATION FORM
ADVT NO.: NO. SLPRB/REC/CONST (APRO & FES) /2018/188 APPLY DATE: 13-MAR-2020

APPLICATION NO. NAME: DATE OF BIRTH:


ANF43928 BIROJA BORO 18-01-2000

FATHERS' NAME: MOTHERS' NAME: CASTE:


BHARAT BORO RAMBHABATI RABHA ST(P)

EMAIL: PHONE: ADD. PHONE: GENDER:


BIROJA781135@GMAIL.COM 9101306590 NA FEMALE

NATIONALITY: RELIGION: EMPLOYMENT NO. :


INDIAN HINDU NA

POST APPLIED FOR :


1 CONSTABLE OF POLICE (COMMUNICATION) IN APRO (PREFERENCE 1)
2 FIREMAN (FAES) (PREFERENCE 2)
3 EMERGENCY RESCUER (FAES) (PREFERENCE 3)
4 CONSTABLE OF POLICE (UB) IN APRO (PREFERENCE 4)

PERMANENT ADDRESS CORRESPONDENCE ADDRESS

VILL- GONGRAPARA, PO- GAMERIMURA VILL- GONGRAPARA,

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


KAMRUP BOKO 781135 KAMRUP BOKO 781135

ACAMEDIC QUALIFICATION: EXTRA CURRICULAR ACTIVITIES:

COLLEGE NAME: EWS NCC CERTIFICATE COMPUTER CERTIFICATE MMV CERTIFICATE


PALASBARI R B HS & MP SCHOOL NA NA NA NA

HIGHEST SPORTS
STREAM: HOME GUARD LMV CERTIFICATE
QUALIFICATION: CERTIFICATE
SCIENCE NA NA
HS(SCIENCE) NONE

MARK IN CARPENTRY
MARK IN PHYSICS: ELECTRONIC / TELECOMMUNICATION / COMPUTER / IT / ALLIED ENVIRONMENT CERTIFICATE
CHEMISTRY: CERTIFICATE
50 NA
55 NA

FIRE FIGHTING / ROCK CLIMBING & SWIMMING / DRIVING


MARK IN MATHS: PERCENTAGE: ITI / FOREMAN CERTIFICATE
TRACKING / MARTIAL ARTS CERTIFICATE CERTIFICATE
35 60.4 % NA
NA 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.

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