GOVERNMENT OF ASSAM

(COMMISIONERATE OF PANCHYAT & RURAL DEVELOPMENT)

APPLICATION FORM
Advertisement No : PDDE(II) 126/2019/53 Dated 27th August, 2020

Applicant Information

Full Name: MINAKSHI DEKA

Registration No: P201272757

Email Id: moonmi.deka@gmail.com

Mobile No: 7002979932

Father's Name MAHENDRA MOHAN DEKA

Mother's Name : BHAGYA LAKSHMI DEKA Date Of Birth : 01/02/1991

Gender : FEMALE Caste : General

Nationality : India Religion : Hinduism

Employment Exchange Registration No : PEO/W-243/14 Economically Weaker Section : NO

Address

Permanent Address
HN 03 BISHNU PATH JONALI, Village/Town/City: KAMRUP METRO, Post Office: Zoo road, Police Station: Geetanagar, Pin: 781024, District: KAMRUP
METRO, State: ASSAM

Present Address
HN 03 BISHNU PATH JONALI, Village/Town/City: KAMRUP METRO, Post Office: Zoo road, Police Station: Geetanagar, Pin: 781024, District: KAMRUP
METRO, State: ASSAM

Educational Qualification

# Particulars Stream/Course Examination Name- Name of the Institution Board/University Year of Percentage
Specialization Specialization/Branch Passing

1 DEGREE SCIENCE BACHELOR OF COMPUTER LALIT CHANDRA BHARALI Gauhati 2012 63.73
APPLICATIONS - BCA COLLEGE university

Language Proficiency Computer Diploma Certificate

# Language Read Write Speak Duration

Name of
1 ENGLISH Y Y Y # Qualification/Course/Certification Description Institute Year Month

2 ASSAMESE Y Y Y 1 Computer Hardware and 6 months IITA 0 6

Networking Management diploma
3 BENGALI Y Y N
course in
4 BODO N N N hardware and
networking
Documents Uploaded List of Work Experience

# Document Name # Name of Organization Designation From Date To Date

1 Passport Photo 1 CEC Software Faculty 01/03/2015 28/02/2016

2 Scanned Copy of Signature 2 GIMT Office Assistant 01/02/2017 15/03/2019

3 Age Proof Certificate

4 Degree Certificate

5 Degree Marksheet Post(s) and Preference

6 Employment Exchange Registration/Card

# Name of the Post Post Preference
7 Computer Diploma : Computer Hardware and
Networking Management 1 Asstt. Block Development Officer (Panchayat) FIRST PREFERENCE

8 Work Exp. Certificate : Organization - CEC 2 Asstt. Block Development Officer (W&C) SECOND PREFERENCE

9 Work Exp. Certificate : Organization - GIMT 3 Asstt. Block Development Officer (Senior Gram Sevak) THIRD PREFERENCE

4 Tax Collector Cum Road Mohrar FOURTH PREFERENCE

5 Junior Assistant (For 5 newly created ZPs) FIFTH PREFERENCE

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.
I hereby declare that I will follow all Covid-19 protocols/restrictions in the examination
hall as per the rules of Govt. Of Assam
I hereby declare that I will not use any electronic gadgets such as Mobile Phone,
Bluetooth devices etc during exam hours and inside the examination hall.
I also declare that I will maintain Social distancing during exam hours and inside the
examination hall.