Perso nal Inf o rmat io n

Co -o perat ive Superviso r & Enviro nment

Post Name
Superviso r
Have you applied against advertisement number:
34/UKSSSC/2021 Dated 30-06-2021 (Co-operative
Supervisor & Environment Supervisor) published by No
UKSSSC
Application Number ECL238909
Application Status Co mplet ed
Candidate's Name MANOJ CHANDRA T HUWAL
Father's Name/Husband's Name SHIV DAT T T HUWAL
Mother's Name LAXMI DEVI
Date of Birth 12/06/1999
Age (As on 01 Jul, 2023) 24 years 0 mont hs 19 days
Gender Male
Marital Status Unmarried
Email Id manXXXXXXXXXXXXXXXXX@gmail.com
Mobile No. 76XXXXX663
Place of filling form Haldawani
Domicile of Uttarakhand? Yes
Nationality Indian

Required Eligibilit y
1.Is your name registered in any District Employment Office located in Uttarakhand State? Yes

1(i).Employee Registration Number UK22ES0100033247

Employment
1(ii).Employment Office District
Office,Nainit al

1(iii).Date of Registration 20/01/2022

1(iv).Registration Date Valid Upto 30/04/2025

2.Are You Employed? No

Have you passed your High School and Intermediate or any other equivalent exam from any recognized Yes
3.
institution situated in the State of Uttarakhand
Are you or your spouse or your parents regular employees of the Armed Forces/Paramilitary Forces
4(i).serving in the state of Uttarakhand and whose services cannot be transferred outside the state of No
Uttarakhand?
Are you or your spouse or your parents regular employees of the State Government/Semi Government
4(ii).organisation serving on a regular basis in the state of Uttarakhand and whose services cannot be No
transferred outside the state of Uttarakhand?
Are you or your spouse or your parents regular employees of Central Government organisation/ Central
4(iii).Government Public Service Undertaking and are working regularly in the State of Uttarakhand and No
whose services cannot be transferred outside the State of Uttarakhand?
Are you permanent resident of Uttarakhand but residing outside Uttarakhand for livelihood/education
 e you pe a e t es de t o Utta a a d but es d g outs de Utta a a d o e ood/educat o
5(i). No
purposes?
Is your spouse or your parents permanent residents of Uttarakhand but are residing outside
5(ii). No
Uttarakhand for livelihood/education purposes?

Cat ego ry / Sub Cat ego ry Reservat io n Det ails

Category EWS

Certification Issuing Authority Tehsildar

Certificate Issuing Date 28/04/2023

Certificate Number UK23RD1000006879

Certificate Issuing District Nainit al

Sub Cat ego ry Det ails

Differently abled(PH) No

Ex-Servicemen No

Dependent of Freedom Fighter (DFF) No

Are you a permanent resident of the State of Uttarakhand covered by
Government Order No. 179/XXX(2)/2021-30(2)/2019, dated 31st
August 2021, for such affected children (whose biological/adoptive
parents both died after the birth of the child)? within a period of up to No
21 years) OR Orphan Child residing in government/voluntary homes
functional and registered under the Department of Women
Empowerment and Child Development in the state of Uttarakhand
Claimed Category/Sub Category EWS

Address Det ails

Present Address
Line1 Village and post -Surang
Line2 Block-Okhalkanda
City / T own / Village Surang
District Nainit al
State Ut t arakhand
Pincode 263157

Permanent Address
Line1 Village and post -Surang
Line2 Block-Okhalkanda
City / T own / Village Surang
District Nainit al
State Ut t arakhand
Pincode 263157

Educat io nal Qualificat io ns Det ails

Date of Marks Maximum Percentage
Q ualification Name of University / University / Issuing Subject / Marks T ype Obtained / Marks / Grade of Marks
T ype Degree Board State Board Final Year Stream CGPA / CPI CGPA / CPI Obtained Obtained /
Marksheet Equivalent
Uttrakhand
High School(10th) High Uttarakhand Board of 2015 High School MARKS 265.00 500.00 - 53.00
School(10th) School Subjects
Education
Biology,
Uttrakhand
Intermediate Board of Chemistry,
Intermediate(12th) Uttarakhand 2017 English, MARKS 292.00 500.00 - 58.40
(Science) School
Education Hindi,
Physics

Pref erent ial Qualificat io n

 Pref erent ial Qualificat io n
Have you Served in the T erritorial army for a minimum period of two years? No

Do You Possesses "B" Certificate of National Cadet Corps? No

Ot her Det ails

Subject for Objective Exam Part-B Group 1 (Physics, Chemist ry, Biology)

Exam Centre Preference 1 Nainit al

Exam Centre Preference 2 Udham Singh Nagar

Is there any criminal case pending against you? No

Whether debarred or Black Listed for Examination/ Selection held by UKPSC / UPSC / Other No
State Public Service Commission?
Candidate ID Proof Vot er Ident it y Card

ID Proof Number APXXXXXX26

Fee Det ails

Application Fee Fee Exempt ed

Declarat io n
1. I MANOJ CHANDRA T HUWAL hereby declare t hat I have caref ully read all t he eligibilit y condit ions ment ioned in t he
advert isement and t he above ment ioned inf ormat ion in t his applicat ion f orm. I accept and complet e t hose requirement s.
एत वारा घोषणा करता ं क मने व ापन म उ ल खत पा ता क सभी शत और इस आवेदन प म द गई उपरो जानकारी को सावधानीपूवक पढ़ लया है। म उन
आव यकता को वीकार करता ं और उ ह पूरा करता ं।
2. I also declare t hat all t he det ails / inf ormat ion given in t his applicat ion f orm is t rue and correct and I have not hidden any f act s
in t hese part iculars / inf ormat ion. If any det ails / inf ormat ion is f ound t o be f alse or incorrect or if any f act s are hidden by me,
t hen my candidat ure should be cancelled. If such sit uat ion comes t o light af t er t he appoint ment , t hen my services should be
t erminat ed.
यह भी घोषणा करता ं क इस आवेदन प म दए गए सभी ववरण/सूचनाएं स य और सही ह और मने इन ववरण /जानकारी म कोई त य नह छपाया है। य द मेरे ारा कोई
ववरण/सूचना अस य या अस य पायी जाती है या कोई त य छु पाया जाता है तो मेरी उ मीदवारी र कर द जाये। अगर नयु के बाद ऐसी त सामने आती है तो मेरी सेवाएं
समा त कर द जानी चा हए।

Place of filling form: Haldawani

Submitted Date & T ime : 12/08/2023 06:27:48
Print Date : 12/08/2023

Signat ure of Candidat e