2/25/24, 2:33 PM Haryana Staff Selection Commission : Registration Print

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

Registration Number 20008278

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

Father's Name harish kumar chawla

Mother's Name raj rani

Date of Birth 14/1/1987

Age as on 21.09.2015 28 Year 8 months 7 days

Gender Female

Marital Status Married

Nationality indian

Category General
District Mewat Cadre NO

Matric with Hindi/Sanskrit

or 10+2/B.A./M.A. with YES
Hindi as one of the
subject ?
QUALIFICATION

Marks Obtained /
Class Name/Qualification Passing Year University/Board Subject
Total Marks
Matric 2002 hbse hindi,eng,maths,science,s.st,physical 417 / 600
10+2 (Senior Secondary) 2004 hbse pcm,hindi,eng 279 / 500
MCA (Regular three year
2010 mdu computers 2113 / 2700
course)
HTET DETAIL

HTET Passing HTET Marks

HTET Roll No. HTET Subject HTET passing Month
Year Obtained

OTHER

rohtak haryana/
Haryana Domicile YES Birth Place and Country
India
Whether Working as a
teacher in privately
managed Govt. aided,
recognized and Govt.
Schools. Age relaxation NO
to the extent of service
rendered as a teacher
subject to a maximum
of 5 years.
Password 2EB44EAAC4
ADDRESS

Permanent Address
419/5 NEAR SHAKTI BHAWAN MEHAM, meham, Rohtak, Pin-124112, Telephone No -9802318483, Email ID-
Corresspondence Address
419/5 NEAR SHAKTI BHAWAN MEHAM, meham, Rohtak, Pin-124112, Telephone No -9802318483
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

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2/25/24, 2:33 PM Haryana Staff Selection Commission : Registration Print
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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