2/25/24, 2:52 PM Haryana Staff Selection Commission : Registration Print

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

Registration Number 20009632

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

Father's Name HAWA SINGH

Mother's Name SANTOSH

Date of Birth 15/6/1985

Age as on 21.09.2015 30 Year 3 months 6 days

Gender Female

Marital Status Un Married

Nationality INDIAN

Category SBC
District Mewat Cadre NO

Matric with Hindi/Sanskrit or

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

Marks Obtained /
Class Name/Qualification Passing Year University/Board Subject
Total Marks
HINDI ENG MATH SS
Matric 2000 HBSE 295 / 600
SCI SKT
HINDI ENG HISTORY
10+2 (Senior Secondary) 2002 HBSE 291 / 500
PHY EDU POL SCI
MCA (Regular three year
2009 MDU ROHTAK COMPUTER SCIENCE 1922 / 2700
course)
Post Graduation 2013 MDU ROHTAK COMPUTER SCIENCE 2279 / 3000
Experience

Name of Salary (in From To Experience

Designation
Institution/Organization Rupees) Date(dd/mm/yyyy) Date(dd/mm/yyyy) (In Months)
GOVT GIRL SR SEC SCHOOL COMPUTER
12000 9/9/2013 22/3/2015 31
MEHAM TEACHER
HTET DETAIL

HTET Passing HTET Marks

HTET Roll No. HTET Subject HTET passing Month
Year Obtained

OTHER

Birth Place and ROHTAK HARYANA/

Haryana Domicile YES
Country INDIA
Whether Working as a
teacher in privately managed
Govt. aided, recognized and
Govt. Schools. Age
NO
relaxation to the extent of
service rendered as a
teacher subject to a
maximum of 5 years.
Password 4A2E20C4D6
ADDRESS

Permanent Address
VPO BAHU AKBAR PUR, ROHTAK, Rohtak, Pin-124001, Telephone No -7404385996, Email ID-
MISS.DEEPIKA37@GMAIL.COM

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2/25/24, 2:52 PM Haryana Staff Selection Commission : Registration Print

Corresspondence Address
VPO BAHU AKBAR PUR, ROHTAK, Rohtak, Pin-124001, Telephone No -7404385996
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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