District Recruitment Bureau

VILLUPURAM DISTRICT
Office of the Joint Registrar of cooperative societies

SALESMEN /é‰gidahsh¦

Registration Number / 30106121

Name of the Applicant /t¨©z¥gjhuu¨‹ bga® : K JAGADEESWARI
Personal Details / Ra étu§fŸ :
Date of Birth / g¨wªj njj¨ : 30-07-1978
Father's / Guardian's Name / jªijahh¦ / fh¥ghsh¦ bgah¦ G KANNAN
Gender / ghy¨d« : Female
Marital Status / j¨Ukz« Mdtuh? : Married
Spouse Name / fzt® bga®/kidt¨ bga® : VENKATESAN
Applicant's Native District as: per family card / Villupuram

Family Card Number/ : NPHH-333910288411

Native State /brhªj khãy« : Tamil Nadu

Native District / brhªj kht£l« : Villupuram
Mother Tongue/jhŒ bkhê : TAMIL
Nationality / njÁa Ïd« : Indian
Religion / kj« : Hindu
Certificate Details / rh‹¿jœfë‹ étu§fŸ :
Communal Category / tF¥ò : Scheduled Caste (SC)
Name of the Sub-Caste /rhj¨ c£g¨u¨t¨‹ bga® : AdiDravida
Certification Number / rh‹¿jœ v© : TN5202205187090
Date of Issue / tH§f¥g£l njj¨ : 02-06-2022
Issuing Authority / rh‹¿jœ tH§f¨a mj¨fhu¨ : TALUK TAHSILDAR
Taluk / t£l« : Tindivanam
District / kht£l« : Villupuram
Are you a Destitute widow ? / No
Mjut‰w t¨jitah ? :

Are you Differently Abled Person ? / No

kh‰W¤ j¨wdhs¨ah? :

Are you an Ex-Serviceman ? / No

K‹dhŸ ÏuhQt¤Âduh? :

Have you been debarred or disqualified by the Public Service Commission or any other recruiting agency from appearing examinations
and selections for specific period or permanently ? / nj®thiza« mšyJ ntW vªj gâ e¨akd Kifikædhnyh nj®ÎfŸ k‰W« bjçÎfëš
fyªJ bfhŸS« cçikæèUªJ j§fis ãuªjukhfnth mšyJ xU F¿¥Ã£l fhy¤Â‰nfh éy¡f¨ it¤njh mšyJ jFj¨a¨‹iknah brŒa¥g£LŸsjh ? : No

Are you Employed ? / No

gâ étu«? :

Do you claim any Priority under G.O.(MS) No 122

Human Resources Management (K2) Department dated 02.11.2021 ? /
(murhiz (ãiy) v© 122, kåj ts nkyh©ik¤ (nf2) Jiw,ehŸ: 02.11.2021 š No
F¿¥Ã£LŸs Áw¥ò¥ Ãh¨Îfë‹ Ñœ VnjD« K‹Dh¨ik nfhUgtuh?

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Applied Date : 2022-10-31 06:24 pm
 District Recruitment Bureau
VILLUPURAM DISTRICT
Office of the Joint Registrar of cooperative societies

Education Qualification Particulars / fšé¤ jF F¿j¦j t¨tu§fŸ :

H.S.C OR Diploma Registration Number Month & Year Of Passing H.S.C board H.S.C Certificate Number

HSC 684197 May 1995 STATE BOARD 1392448

Medium of Instruction Obtained Mark Total Mark Mark Percentage

Tamil 532 1200 44.33

gŸë ÏW tF¥ò / nkšãiy¤ njh¦éš jäiH xU ghlkhf¥ gæ‹WŸÇuh? :

Whether Studied Tamil as one of the Subjects in S.S.L.C/+2? / Yes
1« tF¥ò Kjš 12« tF¥ò tiu jäœ bkhê têahf gæ‹WŸÇuh ? :
Whether Studied 1st standard to 12th standard in Tamil Medium/ No

Do you have Basic Computer Knowledge ? / Yes

mog¦gil fâå fy¦é m¿Î bgw¦WŸÇuh :

Communication Details / bjhlu¦ò F¿j¦j t¨tu§fŸ :

Address of Correspondence / bjhlu¦ò Kftu¨ : Permanent Address / e¨ue¦ju Kftu¨ :
MOOTHA KOIL STREET NO 24 MUTHALAMMAN KOIL STREET

DHADAPURAM VILLAGE AND POST KOLLIYANGUNAM

TINDIVANAM TALUK TINDIVANAM

District / khtl¦lk¦¦ : Villupuram District / khtl¦lk¦¦ : Villupuram

State / khãyk¦ : Tamil Nadu State / khãyk¦ : Tamil Nadu

Pin / mŠrš Fw¨pL : 604207 Pin / mŠrš Fw¨pL : 604304

Email Id / k¨‹dŠrš Kftu¨ : jagadees2k21@gmail.com

Mobile Number / if¥ngÁ v© : 6382947562

Declaration / cWÂ bkhê :

I hereby declare that all the particulars furnished in this application are true, correct and complete to the best of my knowledge and belief. In the event
of any information being found false or incorrect or ineligibility being detected before or after the examination,my selection by the
District Recruitment Bureau,is liable for cancellation . / Ï›é©z¥g¤Âš F¿¥Ã£LŸs étu§fsid¤J« v‹ m¿é‰F v£oatiu c©ik.Ï›é©z¥g¤ij
bghW¤jtiu vJΫ kiw¡f¥gléšiy. nju¦é‰F K‹ngh mšyJ Ãwnfh Ï›étu§fŸ jtW mšyJ c©ik¡F¥ òw«ghdJ mšyJ jFÂæ‹ik vd m¿Í«g£r¤Âš kht£l
MŸnru¦¥ò e¨iya¤jhš eh‹ nj®ªbjL¡f¥g£lJ K‹ mw¨é¥g¨‹w¨ Ïu¤J brŒa¥gLtj‰Fu¨ajhF«.

I accept the above declaration / nk‰Tw¨a cWÂbkhêia V‰W¡ bfhŸ»‹nw‹

Please retain your Application Number and Password emailed to you carefully for further reference. Signature of Applicant

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Applied Date : 2022-10-31 06:24 pm