Application For: spirational Blocks Fellow(ABP Fellow BLOCK: Hares 4 ave , istrict: PBK (MP) 1. | Name of Applicant yquerl Eawoy ar 2. | Applicant's Father's Name Ly) V Shqubay. 3. | Catagory (GENJOBC/SC/ST) 2ice CWCL) 4. | Date of Birth (DateMonth/Year) [227 ee 7 CRF, 7. 5 | Gender 6. | Mobile Number wna ZOU F a 7, | E-Mail ld Prveestleywo Sigh re 24 GF heer]t 3) Marital Sans Uuwarved | 9, | Current Postal Address afelgot, ! Village/Ward eee | Block/Tehsil Feektguk | District Gurcalyrer » | State Pha as foaWN _ 1 Pin Code SGU sory Educational Qualification- Score / iE i soard / Universit Passing ad ea lf tich; Of Beard) perc | | | High School fof 5-1 Ao ; Pipe, aoe, Tee 2 | Higher Secondary | CLénws, (Gp proprinve Vola ad ori 3 | Graduate ah Ur4 ves, _ BTw | gens gg 2023 4 | Post Graduate 21a CAHN "£8 (anna Unveil — 5 | Other ___| Qualifications Se —Data Analysis / Computer Proficiency certificate - ; — Passin [ sno] Certificate/Diploma/Degree | Institution Name |} Affiliation vere Work Experience- i i Institution’ | Job Period Total S.No.| Particulars | Designation | me ae pared oa, [ [\_|[gecra/oae Dre Geek Pay Cant Cre FeawaeaeS Bec seby z : mag CW ELTA) te bea wee} bouspiaak Mang yichyy Ste. May WIIG OP | Lbakvgury) | Poeanee| J Certificate related to Project Management skills or work S.No. | Institution / ‘Name of Subject/Skill Period Total ganization Name FROM | Tp] Year Ea CABY bencterted helt grhSqX Ol Ll Adie natavily ely Leadesbiy bo ans st fe Wat 7,| 2022 [ bux eons Hf belu)) COM Ad bt" ay Thereby declare that I fulfil the eligibility condition mentioned in the advertisement and guidelines of Aspirational Blocks Fellow (ABP Fellow 2024) and that all the statements made in this application are true, complete and correct to the best of my knowledge and belief. I understand that in the event of any information being found false or incorrect at any stage of not satisfying the eligibility conditions mentioned in the advertisement and guidelines of Aspirational Blocks Fellow (ABP Fellow 2024), my candidature will table to be cancelled / terminated, also understand and declare that this is purely a fellowship and does not provide any type of employment ‘or guarantee for any employment in future. [ will not claim any employment in future from Government / Department on this ground. Enclosed:~ ate ele Total No. of Documents. Date... 22 OU 20 27 Signature s frguere leynoVv big, lace:- Name of Candidate