EMPLOYEES' STATE INSURANCE CORPORATION

50132
RECRUITMENT OF UPPER DIVISION CLERK (UDC), STENOGRAPHER (STENO.) AND MULTI-
TASKING STAFF (MTS) IN ESIC

Registration Number : 119023763

Full Name : Sekh Md Ramij

Post: : Multi-Tasking Staff

Region: : West Bengal & Sikkim

Category : OBC

Are you a person with benchmark disability of 40% and above ? : NO

Disability category : -

Type of Disability : -
Do you need compensatory time at the time of examination? : -

Are you suffering from cerebral palsy and your writing speed is : -
affected : ?

If Yes, Do you need compensatory time at the time of examination? : -

Whether your dominant (Writing) hand is affected ? : -

If Yes, Do you need compensatory time at the time of examination? : -

Do you intend to use the services of a scribe ? : -

Religion to which you belong : Muslim

Do you belong to Religious Minority ? : YES

Are you ESIC Employee/ Government Servant who have rendered not : NO
less than 3 years regular and continuous service as on closing date
for receipt of application : ?
Kindly Specify : -

Are you a regular ESIC employee seeking relaxation in fee ? : -

Are you an Ex-Serviceman : ? : NO

Period of Service ( in months) : -

Ex-Servicemen who have already secured employment in civil side : -
under Government in Group ‘C’ & ‘D’ posts on regular basis after
availing of the benefits of reservation given to ex-servicemen
Any other category for relaxation in age : NO

Mention category for age relaxation : -

Nationality : Indian

State/UT to which centre of Preliminary examination belongs : West Bengal

Centre of Preliminary Examination : Kolkata
State/UT to which centre of Main examination belongs : WEST BENGAL

Centre of Main Examination : GREATER KOLKATA

Application Fee / Intimation charges

Payment In : ONLINE
Amount : 500.00

Payment Status : PAID

Reference ID : WHD40772819391

Transaction Date : 16-01-2022

Do you want to receive refund of fees in the same channel by which : -

you are paying fees ?

Account Number : -

Account Type : -
Bank Name : -

Branch Name : -

IFSC Code : -

Name of the Account Holder : -

Personal Details
Date of Birth : 01-01-2001

Age completed as on 15.02.2022 : 21

Gender : Male
Do you have twin brother / sister ? : YES

Name of the twin : Simran sultana

Gender of the twin : Female
Marital Status : Unmarried

Father's Name : Sk Ansarul Haque

Mother's Name : Abida Sultana

Spouse's Name : -
Address for Correspondence
Address 1 : Mahammadpur

Address 2 : Mahammadpur
Address 3 : Mahammadpur

District : East Medinipur

State : WEST BENGAL
Pincode : 721631

Permanent address
Address 1 : Mahammadpur
Address 2 : Mahammadpur

Address 3 : Mahammadpur
District : East Medinipur

State : WEST BENGAL

Pincode : 721631
 Contact Details
Mobile No : +91 6294074094
Alternative Number : +91 8158872062
(Mobile No/Landline No)

Email ID : sramij311@gmail.com
     

Educational Qualification(as on 15.02.2022)

Exam Passed Degree/Subject /Stream Date of Passing % of Marks Class / Grade

Matriculation/10th Matrics pass 27-05-2017 66.00 First Class

HSC/12th Others - Pure Science 27-05-2019 65.00 First Class

Other Details :
  Languages Known Read Write Speak

 Bangali  YES  YES  YES

Uploaded Document Details :

1. Left Thumb Impression

 
2. Hand Written Declaration
 

 
Declaration:
I hereby declare that all the 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 untrue or incorrect at any stage or I am not satisfying any of the eligibility criteria
stipulated, and also in case of creating influence/undue pressure regarding recruitment shall tantamount to cancellation of my candidature.

 
 
 
 
 
 
  

Date:
15-01-2022 Signature of Applicant

Left Thumb Impression

Hand Written Declaration