12/19/2017 :: ONLINE APPLICATION ::

ONLINE APPLICATION FORM

Application No. : 117/TDN/OBC/00066494 Affix recent
1. Name of the Post Applied for : Tradesman Mate passport size
2. Applied Under Category*: OBC colour
Photo(Size -
3. Religion, Caste & Category Belongs to* : HINDU - OBC 4.5cm x
(if belongs to SC/ST/OBC)
3.5cm)
4. State of Origin : ODISHA
5. Gender, Marital Status & Birth Date* : Male / Single / 15 Jun 1993
6. Name of the Candidate (as in Matriculation MR. PAILA BHAVANI
Certificate) : SHANKAR
7. Father's Full Name : PAILA PRAKASH RAO
8. Present Postal Address: PLOT NO-10, NEAR PUMP HOUSE,JHIRPANI,
ROURKELA, SUNDARGARH, PIN - 769042 (ODISHA)
9. Mobile No., Email & Aadhaar Card No. 7609833880 bhavanishankarrao92@gmail.com
632257319027
10. Details of Educational Qualification* (Govt./Govt. Recognised Institute/Organization only)
Qualification Compulsary Subject/Trade Univ/Board PassingYear MarksObt TotalMarks Percentage
10th --NA-- ICSE BOARD 2009 274 700 39.14
Experience if any* (Govt./Govt. Recognised Institute/Organization only) :

11. Whether Ex-ServiceMan* : NO

12. Whether Physically Handicapped* : NO

13. Whether Sport Man* : NO
14. Recruitment Type : Advt Applied Candidate

15. Preferred Location : 1.Pune, 2.Chennai, 3.Jodhpur

16. Declaration :
I, hereby solemnly declare that all the statements made in the application are true, complete and
correct to the best of my knowledge and belief. In the event of any information/document being found
false/incorrect/not in order or ineligibility being detected before or after the test/interview, my
candidature will stand automatically cancelled and appropriate action can be taken against me.
I understand that merely filling up of preferred location for employment has no bearing on my
selection for the units located in preferred location. I am ready to work at any location/unit post my
selection for any post. I also understand that post selection I have all India liability and am ready to
get posted to any location /station/unit be it in peace, field, modified field or CI Ops, High Altitude
Area, anywhere in India. I also take an undertaking to not ask for change of location, any
compassionate grounds, posting till 20 years of my service.
Note:- *On receipt of intimation of your selection, you are required to bring this form with
photocopies of all required certificates at the time of reporting to this Academy.

Place : ROURKELA Signature : App Date : 19/12/2017

Date : 19/12/2017 Name of the Applicant : PAILA BHAVANI SHANKAR
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