CENTRALSILK BOARD ©, nity fetes = Goverment Of india A (S8Conlt BTA Laut Medial, i ‘Bemglur 560068, Karnataka we website — wynsb govin CENTRAL SILK BOARD Recruitment of Various Posts Registration Number Full Name Post applied Category ‘Are you a person with benchmark disability of 40% ‘and above ? Percentage of Disa Type of Disability Sub-Type of Disability Sub-Type of Multiple Disabilities, Do you need compensatory time at the time of examination ? ‘Are you suffering from cerebral palsy and your writing speed is affected ? IYes, Do you need compensatory time at the time of examination? ‘Whether your dominant (Writing) hand is affected ? IFYes, 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 Whether you belong to Religious Minority Community ? ‘Are you seeking relaxation under widow /divorced ‘women / women judicially Separated from their husband and who are not re-married ? ‘Are you claiming age relaxation being a Departmental candidate or Central Government candidate ? Period of Service (in months) ‘Are you claimimg relaxation as Farm worker in Central Silk Board ? ‘Are you an Ex-Servicemen (including ECs! S8COs) ? ‘Are you a Defence Services Personnel disabled in ‘operations during hostilities with any foreign country 210032584 ANIKET DAS Upper Division Clerk Group ¢ ews: No Hindu No No No Noor ina disturbed area and released as a ‘consequence thereof? Poriod of Service as an Ex-Serviceman (in months): - ‘Are you a Meritorious Sportsperson :? 1 NO Nationality / Citizenship, + Indian State/UT to which the Examination Centre Belong: Ocisha Centre of Examination Bhubaneswar Language of Skil Test + English Application Fee / Intimation charges. Payment in + ONLINE Feos + 695.60 Tax + 11440 (GST) Amount + 750.00 Payment Status : PAID Reference ID + YHD41646082397 Transaction Date + 2042-2022 Personal Details Date of Birth 2 23-01-1998 ‘Age completed as on 16.01.2023 2 24 Gender 2 MALE Do you have twin brother / sister ? : NO Gender of the twin Pe Name of the twin Pe Marital Status : Unmarried Father's Name : BYOMKESH DAS Mother's Name 1 GITARANI DEVI Spouse's Name Pe ‘Address for Correspondence ‘Address 1 + MANGALA GHAT ROAD Address 2 : NEAR BALI SCHOOL District : PURI State ORISSA Pincode 752001 Permanent address ‘Adress 1 : MANGALA GHAT ROAD ‘Address 2 + NEAR BALI SCHOOL District + PURI State + ORISSA Pincode 752001 State for GST invoicing Correspondence ‘Address (ORISSA)Contact Details Mobile No +91 6370350394 Allornative Number . (Mobile No/Landline No) Email ID ‘akpuri833@yahoo.com Educational Qualification(as on 16.01.2023) Exam Passed Dogroc/Subject /Stream Date of ——% of Marks Class / Grado Passing $.8.CMatriculation Others MATRICULATION. 30-04-2014 83.00 First Class Diploma Others - SCIENCE 13-05-2016 69.83, First Class Graduation / equivalent Science 16072019 61.83 First Class Post Graduation Others - MATHEMATICS 57.58 Second Class Do you have speed of thirty-five words per: YES ‘minute in English or thiry words per ‘minute in Hindi Typeweting (thirty-five ‘words per minute and thtty words por minute correspond to ten thousand five hundred key depressions per hour or nine thousand key depressions per hour on an average of five key depressions for each word) ? work experience details as on 16.01.2023 (Start from present Employer) Name ofthe Designation Total Period of Service Nature of Duties Reason of Years of Employer From To leaving Experience (rvimmioD) Presently YES working? DISTINSTITUTE ICT 20/05/2022 2911212022 DATAENTRY & ono oF INSTRUCTOR ACADE EDU &TRINING mic PURI OPERATIONS Total Experience in months : 7 Other Details Whether any criminal case is pending? : NO Ifyes, please provide the details - ‘Whether you have convicted in any No criminal case ? Ityes, please provide the details peENGLISH YES YES Yes, HINDI YES YES Yes, ODIA Yes Yes Yes, Uploaded Document Details 41. Left Thumb Impression 2, Hand Written Declaration Declaration: | hereby declare that all the statements made in this application are true, complete and correct to the best of my knowledge and belief. | understand that in the event of any information being found untrue or incorrect at any stage or | ‘am not satisfying any ofthe eligibility criteria stipulated, and also in case of creating influence/undue pressure regarding recruitment shall tantamount to cancellation of my candidature, Ae ht Bas Date: 29-12-2022 Left Thumb Impression “x hiket Bap Lovely abelame that all Hes inbernradiog Guslimitbieal pre in than afpbiahiry foo is Seed true andl vali F vvll present Ce fafferkig ohcumed: as ‘anal cider cegureal.” Hand Written Declaration