9/27/2019 Andhra Pradesh Grama/Ward Sachivalayam

Antecedent Form

Personal Details

VSWS HallTicket Number 191009010747

Applicant Name KAVALI DILLIPRASANTH

Post Applied Panchayat Secretary (Grade-VI) Digital Assistant

Date Of Birth of Applicant 05/06/1993

Mobile 8978402958

Religion HINDU

Community BC-B
Goud (Ediga) Gouda (Gamella) Kalalee, Goundla, Se balija of
Community Sub Caste Vishaphapatnam, East Godavari, West Godavari and Krishna
Districts and Srisayana (Segidi)
narayanapuram village srikalahas mandal chi oor district
Place Of Birth
andhrapradesh
District To Which Belong CHITTOOR

Mar al Status UNMARRIED

Present District CHITTOOR

DNO1-127,NARAYANAPURAM VILLAGE,NARAYANAPURAM
Present Address
VILLAGE,SRIKALAHASTI,517640
Permanent District CHITTOOR
DNO1-127,NARAYANAPURAM VILLAGE,NARAYANAPURAM
Permanent Address
VILLAGE,SRIKALAHASTI,517640

PRECEEDING RESIDENTIAL DETAILS

From To
Sl.No Residential Address Police Station & District
Month/Year Month/Year

D.NO.1-127,NARAYANAPURAM SRIKALAHASTI RURAL POLICE

1 09/2019 09/2018 VILLAGE,SRIKALAHASTI MANDAL,CHITTOOR STATION,TIRUPATI URBAN
DIST,ANDHRAPRADESH DISTRICT.

D.NO.1-127,NARAYANAPURAM SRIKALAHASTI RURAL POLICE

2 09/2018 09/2017 VILLAGE,SRIKALAHASTI MANDAL,CHITTOOR STATION,TIRUPATI URBAN
DIST,ANDHRAPRADESH. DISTRICT.

D.NO.1-127,NARAYANAPURAM SRIKALAHASTI RURAL POLICE

3 09/2017 09/2016 VILLAGE,SRIKALAHASTI MANDAL,CHITTOOR STATION,TIRUPATI URBAN
DIST,ANDHRAPRADESH. DISTRICT.

D.NO.1-127,NARAYANAPURAM SRIKALAHASTI RURAL POLICE

4 09/2016 09/2015 VILLAGE,SRIKALAHASTI MANDAL,CHITTOOR STATION,TIRUPATI URBAN
DIST,ANDHRAPRADESH. DISTRICT.

D.NO.1-127,NARAYANAPURAM SRIKALAHASTI RURAL POLICE

5 09/2015 09/2014 VILLAGE,SRIKALAHASTI MANDAL,CHITTOOR STATION,TIRUPATI URBAN
DIST,ANDHRAPRADESH. DISTRICT.

Father Details

Father Name K RAJA

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Profession/Job No

Postal District CHITTOOR

Postal Address DNO 1-127,NARAYANAPURAM VILLAGE,NARAYANAPURAM VILLAGE,SRIKALAHASTI,517640

Permanent District CHITTOOR

Permanent Address DNO 1-127,NARAYANAPURAM VILLAGE,NARAYANAPURAM VILLAGE,SRIKALAHASTI,517640

EDUCATION QUALIFICATION DETAILS

Examination
Name Of School/College Entering Leaving RegNo & Police Station
Course
Address Date Date Passed & District
Details

Z P H S SCHOOL SRIKALAHASTI
URANDUR,SRIKALAHASTI RURAL POLICE
SSC/Matriculation 06/2005 03/2008 0612208
MANDAL,CHITTOOR STATION,TIRUPATI
DIST,ANDHARAPRADESH URBAN DISTRICT.

VIKRAM JUNIOR SRIKALAHASTI

COLLEGE,SRIKALAHASTI 1009226789,MPC RURAL POLICE
Intermediate/Diploma 06/2008 04/2019
MANDAL,CHITTOOR GROUP STATION,TIRUPATI
DIST,ANDHARAPRADESH URBAN DISTRICT.

SRIKALAHATEESWARA INSTIUTE SRIKALAHASTI

Graduation/Professional OF TECHNOLOGYSRIKALAHASTI 10381A0209,EEE RURAL POLICE
09/2010 06/2015
Course MANDAL,CHITTOOR BRANCH STATION,TIRUPATI
DIST,ANDHARAPRADESH URBAN DISTRICT.

Post Graduation --- --- --- --- ---

Any other Qualification --- --- --- --- ---

Case Details

Is Arreted By Police.convicted by Court Of Law Under any

No
state/central Laws

Have you ever been arrested No

Have you ever been prosecuted No

Have you ever been kept under deten on No

Have you ever been bound down No

Have you ever been fined by a Court of Law No

Have you ever been convicted by a court of Law No

Have you ever been debarred from any examina on or

rus cated by
No
any university or any other educa onal
authority/ins tu on

Have you ever been debarred /disqualified by any Public

Service
Commission/Staff Selec on Commission/or any other No
recruitment
board for any of its examina on/selec on

Is any case pending against you in any court of law at

No
the me of filling up this Antecedents form

Is any case pending against you in any University or other No

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educa onal
authority/ins tu on/ at the me of filling of this
Antecedents Form?

Whether discharged/expelled/with drawn from any

training/ins tu on under No
the Government or otherwise?

RESPONSIBLE PERSON DETAILS

First Preference Second Preference

Name in Full Sur Name MADA MUNEENDRA NIMMALA LEELAMOHAN

Given Name If Any -- --

Fathers Name M CHAKRAPANI N CHIRANJEEVULU

House/Apart/Flat No 16-35A 1-163

Street and Road NARAYANAPURAM VILLAGE NARAYANAPURAM VILLAGE

Village NARAYANAPURAM VILLAGE NARAYANAPURAM VILLAGE

Mandal/Taluk SRIKALAHASTI SRIKALAHASTI

Town/City NARAYANAPURAM NARAYANAPURAM

District CHITTOOR CHITTOOR

Pin Code 517640 517640

Urban/Rural RURAL RURAL

DECLARATION DETAILS
1. I hereby declare that the statements made In this form are true to the best of my knowledge and
belief.
2. I am married / unmarried and have only one wife living ( delete which Is not applicable).
3. I am fully aware that furnishing of false Information or suppression of any factual Information in the
Antecedents Form would be a disqualfication and is likely to render me unfit for employment under the
Government.
4. I am also fully aware that If It comes to notice at any time during my service that false Information
has been furnished or that there has been suppression of factual Information in the Antecedents Form,
my services would be liable to be terminated solely on this ground.
Date Signature of the Candidate
Place (Full Name: )

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