Odisha Staff Selection Commission (OSSC) Page 1

26 Jan 2023
Copy of the Online Application Form filled-in for the Post of
Amin - 2022
Advertisement Details
Advertisement Number : IIE-148/2022-7302/OSSC Recruitment Year : 2022
Advertisement Date : 27/12/2022
Registration and Application Details
Applied to : Odisha Staff Selection Commission (OSSC)
Application Number : OD0730222AM-00112730
Application Initiation Date : 26/01/2023 19:34:17
& Time
Application Submission : 26/01/2023 19:38:37
Date & Time
Registration Number : 00141403

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Registered User Name : Subha20220

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Email Id : subh130996@gmail.com

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Mobile No. : 7749064266

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Alternate Mobile No. : 7749064266

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Post Applied for : Amin 2A 23
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Cadre : STATE CADRE

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Essential Compliance Details

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Restrictions, if any, imposed by any Recruitment Commissions/Boards

Have you been debarred from appearing the recruitment examination of any : NO
Commission/Board?
NOC Details
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Presently are you in Govt. : NO

Service ?
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Odia Language Knowledge

Can you speak, read & write : Can Speak Odia, Read Odia & Write Odia
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Odia?
Odia Passout Standard : Passed Matriculation or equivalent examination with Odia as medium of examination in non-
Language subject
Personal Details
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Name of Applicant : SUBHASISH NAYAK

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Father's Name : ANIL KUMAR NAYAK

Mother's Name : CHANDA NAYAK
Gender : MALE
Date of Birth : 13/09/1996
Age as on (01/01/2022 ) : 25 Years 3 Months 18 Days
Category : SOCIALLY EDUCATIONALLY BACKWARD CLASS ( SEBC )
Sub-category of the applied : AGHARIA
Category
Nationality : Indian
Religion : Hinduism
Personal Identificantion : A MOLE ON NOSE
Mark
Marital Status : Unmarried
Have any of your family members been working in the Odisha Staff Selection Commission : NO
 Odisha Staff Selection Commission (OSSC) Page 2
26 Jan 2023
Copy of the Online Application Form filled-in for the Post of
Amin - 2022
(OSSC) ?
Address Details
Permanent Address AT-BHALUTAL, City/Town - BARGARH, Post Office - RUCHIDA, Police Station - AMBABHONA,
Tahasil - AMBABHONA-N TAHASIL, BARGARH, ODISHA , Pincode - 768045
Address for AT-BHALUTAL City/Town - BARGARH, Post Office - RUCHIDA, Police Station - AMBABHONA,
Tahasil - AMBABHONA-N TAHASIL, BARGARH, ODISHA, Pincode - 768045
Communication
Alternate Mobile No.7749064266
Education Details
Qualification Passing Board/Council/University Secured Mark Total Mark Percentage Grade Passing
Year (without extra (without extra (without extra Attempt
optional) optional) optional)

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10th (HSCE) or equivalent

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10th (HSCE) 2012 G P H S KAPASIRA 254 600 42.33333% --

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BOARD OF Third Division

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SECONDARY
EDUCATION, ODISHA

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CR. No.A1-12-018667
MS. No.018667
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+2 or 12th
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+2 (HSEC) 2014 A G B H S SCHOOL 249 500 49.80000% --

(Science) PUSORE RAIGARH
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Third Division
CHHATTISGARH BORD
OF SECONDARY
EDUCATION RAIPUR

CR. No.14200371
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MS. No.14125135
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CR. No. : Certificate Number, MS. No. : Marksheets No.

Test wise Centre Preference Details

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1st Preference : BARGARH DISTRICT

2nd Preference : SAMBALPUR DISTRICT

3rd Preference : KHORDHA DISTRICT

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4th Preference : CUTTACK DISTRICT

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Miscellaneous Details
Computer Knowledge : Yes
Language opted to answer the : English
Questions in all papers except the
Language papers
Self Declaration
I, Subhasish Nayak, Son of Anil Kumar Nayak, Age 26 Years 4 months 13 days, Caste Socially Educationally Backward Class
Resident of Village/Street/Lane ---------, P.O. Ruchida, P.S Ambabhona, Town (NAC/Municipal Corporation) Bargarh, Tahasil
Ambabhona-N Tahasil, Resident Of District Of Bargarh, Odisha, PIN Code 768045, do hereby declare that I belong to the (Sub Caste)
Agharia community which is recognized as a Socially & Educationally backward class by the Government of Odisha for the purpose of
reservation in services under the State Government. I also further declare that I do not belong to persons/sections (Creamy Layer).
 Odisha Staff Selection Commission (OSSC) Page 3
26 Jan 2023
Copy of the Online Application Form filled-in for the Post of
Amin - 2022
Undertaking
I do hereby declare that all statements made in this application are true, complete and correct to the best of my knowledge and belief. In
the event of information being found false or incorrect, or ineligibility being detected before or after the examination, action can be
taken against me by the Commission. I also hereby give my consent that whenever required the information furnished and to be
furnished by me during the course of Registration/Re-registration and Application may be used by the Commission or may be shared for
bonafide Government Purpose.

I, SUBHASISH NAYAK, S/O of ANIL KUMAR NAYAK, Aged 26 years resident of district of BARGARH hereby declare that the
information given above and in the enclosed documents is true to the best of my knowledge and belief and nothing has been concealed
therein. I am well aware of the fact that if the information given by me is proved false/not true, I will have to face the punishment as per
the law. Also, all the benefits availed by me shall be summarily withdrawn.

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I Accept the Terms and Conditions.

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Uploaded LEFT THUMB Impression of Applicant Uploaded Signature of the Applicant
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Note : Application shall be valid after verification of (i) all uploaded documents.

This is a computer report, generated through OSSC portal (www.ossc.gov.in) and does not require any seal and signature of the issuing authority.
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