Application Form

Department of Science & Technology, Government of Bihar

Application for Direct Recruitment of Karyalay Parichari
(Advertisement no. 02/2022 )
Application Details
Application ID :  
OAD/00336755 Application Date :
20-Oct-2022 Post Applied For :
Karyalay Parichari

Personal Details
Applicant Name RATHOD SHIVKUMAR DIPAKBHAI
Father's Name DIPAKBHAI
Mother's Name SITABEN
Marital Status Un-Married
Spouse Name
Ex Serviceman No
Date of Birth 03-Mar-2003
Age as on (01.08.2022) 19 Years 5 Months
Gender Male
State of Domicile Other State
State Name GUJARAT
Category UR

Nationality Indian
Physically Handicapped No
Category of Physically
Handicapped
Percentage of Physically
Handicapped
WARD of Freedom Fighter No
Email ID shivrathod3303@gmail.com
Mobile No. 9265734373
Phone With STD Code
Identification Marks NO MARK

Address for Correspondence

Address 450,VERAI FALIYA, GANESH SISODARA, NAVSARI, GUJRAT
450,VERAI FALIYA,
GANESH SISODARA, NAVSARI, GUJRAT
Pin Code 396463

Permanent Address
Address 450,VERAI FALIYA, GANESH SISODARA, NAVSARI, GUJRAT
450,VERAI FALIYA,
GANESH SISODARA, NAVSARI, GUJRAT
Pin Code 396463

Educational Qualification
Qualification Board/University Institute/ School/ College Name Certificate Passing Full Marks % of
No Year Marks Obtained Marks
I.Matric GSEB SETH H.C.PAREKH, NAVSARI HIGH B2399779 2018 600 440 73.333
SCHOOL, NAVSARI

Certificate Details
Sl. No. Certificate Name Issuing Authority Certificate No. Issue Date
1 Domicile Certificate
2 Caste Certificate
3 Disability Certificate
Ward of Freedom Fighter
4
Certificate
 5 Experience Certificate

Experience Details
Whether worked as a class IV Employee under the world bank polytechnic education
No
strengthening project in Department of Science & Technology, Government of Bihar,
Patna
Year Experience Claimed 0

Point Details
Educational Point 73.333
Experience Point 0
Total Point 73.333

I hereby declare that I am a citizen of India. The entries in this application form
are complete, true and correct to the best of
my knowledge and belief. I have read
carefully all the rules and provisions related to this advertisement and I promise
to
follow these and also promise that I will not use any unfair means during the
selection process. I fulfill all the eligibility
criteria i.e. Age limit, educational
qualification as prescribed in the advertisement. I have all eligibility certificates,
whenever the Department of Science and Technology, Bihar, Patna will ask for it,
i will produce the same failing which my
candidature can be cancelled by the Department
of Science and Technology, Bihar, Patna at any time. In case of any
information
provided by me is found to be false or incorrect before or after the selection,
the Department of Science and
Technology, Bihar, Patna will have the right to cancel
my candidature and take appropriate legal action against me. I
declare that I have
filled only one application for this advertisement.

Date:-
20-Oct-2022
Signature of Applicant (In English) Signature of Applicant (In Hindi)