2/25/24, 2:51 PM Haryana Staff Selection Commission : Registration Print

APPLICATION FORM | Haryana Staff Selection Commission (Advt. No. 5 / 2015 )

Registration Number 20002720

Post Applied For PGT Computer Science (Cat.No.1)
Applicant's Name Sahil

Father's Name Naresh Kumar

Mother's Name Shanti Devi

Date of Birth 4/3/1989

Age as on 21.09.2015 26 Year 6 months 17 days

Gender Male

Marital Status Un Married

Nationality Indian

Category BCA
District Mewat Cadre NO

Matric with
Hindi/Sanskrit or
YES
10+2/B.A./M.A. with
Hindi as one of the
subject ?
Aadhar Card No.
490213435171
(Desirable)
QUALIFICATION

Marks Obtained /
Class Name/Qualification Passing Year University/Board Subject
Total Marks
Matric 2003 HBSE Hindi,Eng.,Math,Sci,SS,Sanskrit 399 / 600
10+2 (Senior
2005 HBSE Hindi,Eng.,Acc.,Comm.,Eco. 298 / 500
Secondary)
MCA (Regular three year
2011 GJUHissar Computer Application 1555 / 2700
course)
Experience

Experience
Name of Salary (in To
Designation From Date(dd/mm/yyyy) (In
Institution/Organization Rupees) Date(dd/mm/yyyy)
Months)
Computer
D.A.V. SchoolPundri 5500 5/7/2011 31/5/2012 10
Teacher
Computer
D.A.V.SchoolPundri 5500 9/7/2012 31/5/2013 10
Teacher
Computer
G.H.S.SangrauliPundri 12000 9/9/2013 22/3/2015 19
Teacher
HTET DETAIL

HTET HTET Passing HTET Marks

HTET Roll No. HTET passing Month
Subject Year Obtained

OTHER

PundriDistt
Haryana Domicile YES Birth Place and Country KaithalHaryana/
India
Whether Working as a NO
teacher in privately
managed Govt. aided,
recognized and Govt.
Schools. Age relaxation
to the extent of

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2/25/24, 2:51 PM Haryana Staff Selection Commission : Registration Print
service rendered as a
teacher subject to a
maximum of 5 years.
Password 07C561F240
ADDRESS

Permanent Address
Indira nagar,Ward No. 1,Pundri, Pundri, Kaithal, Pin-136026, Telephone No -9813667001, Email ID-
sahilcool64@gmail.com
Corresspondence Address
Indira nagar,Ward No. 1,Pundri, Pundri, Kaithal, Pin-136026, Telephone No -9813667001
DECLARATION: I hereby declare that:-

1.All statements made in this application form regarding age limit,educational qualifications & experience etc.
are true, correct and complete to the best of my knowledge, belief, record and nothing has been concealed
therein.
In the event of any information being found/detected false, incorrect, incomplete and ineligible before or after
the interview/selection/appointment then my candidature may be cancelled and any legal action as per law can
be intiated/taken against me.
2. I have read the terms and conditions prescribed in advertisement carefully and accordingly, I hereby
undertake to abide by them. I, also, fulfill all the conditions of eligibilty as per relevant rules and instructions
prescribed by Government of Haryana from time to time.
3. I have never been convicted by any competent court of law.

SIGNATURE

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