Professional Documents
Culture Documents
1
Copy of the Provisional Re-Registration Form submitted online for the Post of
Multipurpose Health Worker(Female) -2023
UT
Husband's Name : BRAJESH KUMAR PRADHAN
Mother's Name
ILI WF
: MUKTA ROUT
Gender : FEMALE
Date of Birth :
RO
21/06/1986
- M - MH
language ?
36
Your Odia language Passing Standard : Passed Odia as language subject in the final examination of Class-VII or above
from a School or Educational Institution recognised by the Government of Odisha
01 (OS
or Central Government
Undertaking
I do hereby solemnly declare that I have carefully gone through the Recruitment Advertisement of the Commission for the post mentioned
above and I fulfill all the conditions of eligibility prescribed for admission to the examination. I further declare that the information furnished and the
copies of the documents uploaded by me for registration/reregistration of my name for the recruitment examination for the post mentioned above are
true and relevant. If any such information or document or undertaking provided by me is/are found false or irrelevant during or after selection, my
candidature/selection shall be cancelled and I shall be liable to penal action as per law. Further I declare that whenever required the information
furnished and to be furnished by me during the course of Registration and Application may be used by the Commission or may be shared for bonafide
Government Purpose only.
Signature of Applicant
Note :
1) It may be noted that mere Registration/Re-registration does not mean complete filing of online Application.
Hence you are advised to fill up and submit the online Application as per the guidance of the system after
completing the Registration/Re-registration.Incomplete applications shall be summarily rejected.
2) This is a computer report generated through OSSSC portal (www.osssc.gov.in) and does not require any seal
and signature of the issuing authority.