EMPLOYEES' STATE INSURANCE CORPORATION 370130

RECRUITMENT OF UPPER DIVISION CLERK (UDC), STENOGRAPHER (STENO.) AND MULTI-

TASKING STAFF (MTS) IN ESIC

Registration Number : 119050176

Full Name : Purushottam Roy
Post: : Multi-Tasking Staff
Region: : West Bengal
Category : SC

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 : Hindu
Do you belong to Religious Minority ? : NO

Are you ESIC Employee/ Government Servant who have : NO

rendered not 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 : 250.00
Payment Status : PAID

Reference ID : WHD40772015929
Transaction Date : 16-01-2022

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

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 : 17-12-1997

Age completed as on 15.02.2022 : 24

Gender : Male
Do you have twin brother / sister ? : NO

Name of the twin : -

Gender of the twin : -

Marital Status : Unmarried

Father's Name : Late Chanchal Roy

Mother's Name : Piklu Roy

Spouse's Name : -

Address for Correspondence

Address 1 : 27A Ultadanga Road

Address 2 : Near United Club

Address 3 : Shayambazar

District : Kolkata

State : WEST BENGAL

Pincode : 700004
Permanent address

Address 1 : Indian dress house

Address 2 : Jessore Road

Address 3 : Habra
District : NORTH 24 PARAGANAS

State : WEST BENGAL

Pincode : 743263

Contact Details
Mobile No : +91 7908171178

Alternative Number : +91 9038510247

(Mobile No/Landline No)

Email ID : purushottamroy077@gmail.com
     
Educational Qualification(as on 15.02.2022)

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

Passing

Matriculation/10th ICSE Sci Eco HistGeo 21-05-2014 68.00 First Class

HSC/12th Others - CBSE Sci Maths Eng 21-05-2016 70.00 First Class

Graduation/Equivalent Others - BE in EIE 18-09-2020 75.00 First Class

Work Experience details (Start from present Employer)

Name of the Employer Designation Total Period of Service Nature of Duties Reason of Years of
From To leaving Experience
(YY/MM/DD)

Presently : YES
working?

Purushottam Roy GAT in BPCL 21/06/2021 16/01/2022 LPG Prod Earthpit 0/6/27
Test Lorry Inspec

Total Experience in months : 6

Other Details :

  Languages Known Read Write Speak

 English  YES  YES  YES

 Bengali  YES  YES  YES

 Hindi  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:
16-01-2022 Signature of Applicant
Left Thumb Impression

Hand Written Declaration