X-1 Form

Personal Details
Registration No. OD26120234596
Registration Type ONLINE Registration
Application Date 27 Feb 2023
1. Name SAMBIT   KUMAR   MOHAPATRA
2. Father's Name
SUBASH CHANDRA MOHAPATRA Spouse Name
/Guardian's Name
3. Mother's Name BABILATA MISHRA
4. Date of Birth 9 May 2001
5. Place of Birth NA
6. Gender Male
7. Urban/Rural RURAL
8. Marital Status UNMARRIED
9. Email sambitmohapatra5161@gmail.com
10. Phone Number 6371671228 Mobile Number 6371671228
11. Caste GENERAL
12. Religion HINDUISM
13. Language Details
Language Known Proficiency
ENGLISH READ AND WRITE AND SPEAK
ODIA READ AND WRITE AND SPEAK
14. Physical Standards
Weight
Height (in Cms) 0 0
(in Kgs)
Wear
Chest (in Cms) 0 Yes
Glasses
Disability (More than
40%)
Blood Group NA
15. Address JAGANNATHPUR,SATAPADA
BRAHMAGIRI
PURI
ODISHA
PIN code - 752011
16. Qualification Details
School/Institute
Exam Passed Board Division PassYear MediumInstruction Percentage Subjects Specialization
Name
Balukeswar Dev
BOARD OF SECONDARY
10TH/MATRIC PASS FIRST 2016 High School, ENGLISH 81.00% WORK EDUCATION ,
EDUCATION,CUTTACK,ODISHA
pirijipur
Koustuv Institute
12TH/INTERMEDIATE BOARD OF SECONDARY
FIRST 2018 of Science , ENGLISH 64.00% YOGA ,
SCIENCE EDUCATION,CUTTACK,ODISHA
Bhubaneswar
Udaynnath
Autonomous
UTKAL CHEMISTRY ,PHYSICS
GRADUATE FIRST 2021 College of Science 67.00%
UNIVERSITY,BHUBANESWAR ,
And Technology,
Adaspur
17. NCO Details
Not Available

18. Exclude NCO Details

Not Available
19. Trade

20. Relocation Option

21. Salary Details
Local Min Salary
Out Min Salary
22. Experience Details
From- Type-of- Pay-On-
Name-Of-Employer Designation To-Date NCO Nature-of-Work Sector
Date Job Leaving(Rs./month)
No Experience Details.
23. Ex-Serviceman Details
No Exserviceman Details.

24. License
Not Available

25. NCC and Others

Not Available

26. Sports
Not Available
27. Remarks  
black mole
on right
28. Passport Number   29. Identification Mark hand 

All the above information is based on my inputs and is true to the best of my knowledge. If any information furnished by me turns out to be false
subsequely,my registation may be cancelled.

(Employment Officer)          
District Employment Exchange, Puri