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Print Application Form

Application  Photo & Signature  Other Details 

Fee Deposition & Final Submission  Print Application Form 
 Uttar Pradesh Subordinate Services Selection Commission,Lucknow
उत्तर प्रदेश अधीनस्थ सेवा चयन आयोग, लखनऊ
Detailed Application Form ( विस्तृत आवेदन पत्र )
Under: PRELIMINARY ELIGIBILITY TEST (PET) 2022

Notification Details :

Advertisement Number :
08-Exam/2023

Applied For :
Junior Assistant Junior Clerk and Assistant Level- III,

Personal Details

Registration Number.

55301965237
Advertisement / Notification No

08-Exam/2023
Candidate's Name

AVIRAL SHUKLA

Father's / Husband's Name

RAVISHANKAR SHUKLA

Mother's Name

RASHMI SHUKLA

Date of Birth
 Date of Birth

05/08/2002

Domicile of Uttar Pradesh

Yes

Home State

UTTAR PRADESH

Home District

SITAPUR

Gender

Male

Category

General

Economically Weaker Sections (EWS)

Yes

Are you Married ?

No

Mobile Number

83* * * *4765

Email ID

* * *ralshukla500@gmail.com

Candidate's EWS Details

EWS Possess :
Yes
EWS Certificate Date :
29/09/2023
EWS Certificate No. :
401
EWS Issuing Authority :
Tehsildar Laharpur Sitapur Uttar Pradesh

Other Details

Are you a Dependent of UP Freedom Fighter?

No

Are you a U.P. Ex. Army?

No

Are you an ECO/SSCO/CO Of Army ?

No

Are you Handicapped of Uttar Pradesh?

No

Are you Blind Or Have Vision problem?

 No

Are you Deaf or Have hearing problem?

No

Have you any physical Problem?

No

Have you psychological/ neurological problem? :

No

Have you Multiple Disabilities? :

No

Are you a Skilled Player of Uttar Pradesh?

No

Level of Player

N/A

Employment Details

Never Employment in Uttar Pradesh

Additional age relaxation other than above reasons(Caste category,Sub category,Service duration
etc.)
Are you claiming any additional age relaxation ?

No

Academic Details

Examination Board Name Year of Roll Is Obtained Total Percentage

Passed Passing Number Grade Marks Marks
System

High School CENTRAL BOARD OF 2018 5122583 No 512 600 85.33

SECONDARY
EDUCATION

Intermediate CENTRAL BOARD OF 2020 23666713 No 328 500 65.6

SECONDARY
EDUCATION

Bank Transaction Details

Bank Name - Payment Mode :

State Bank Of India - INB

Fees, Transaction ID - Date:

Rs. 25.00 , CPADDFBBW6 -30/09/2023

Details of essential qualifications for the post (Junior Assistant Junior Clerk and Assistant Level- III,
)↓

Sr Qualification Acquired Name of Board/ Year Of Certificate/Roll Marks

No. Institute/University Passing Number Detail
 Issue Date

1 Must have Yes 2020 23666713 Is

passed CENTRAL BOARD OF Grade:
Intermediate SECONDARY 13/07/2020 No
Examination EDUCATION Obt
from Board of Marks:
High School 328.00
and Tot
Intermediate Marks:
Education U.P. 500.00
or any Per:
Examination 65.60
recognized by
the
Government
as equivalent
there to.

2 Minimum 25 Yes N/A N/A N/A Is

words per Grade:
minute and 30 N/A N/A
words per Obt
minute typing Marks:
speed is N/A
essential in Tot
Hindi and Marks:
English N/A
respectively. Per:
N/A
3 Must have Yes 2021 GO2103089280 Is
CCC NATIONAL Grade:
Certificate in INSTITUTE OF 16/04/2021 N/A
Computer ELECTRONICS AND Obt
application INFORMATION Marks:
provided by TECHNOLOGY N/A
DOEACC Tot
Society or any Marks:
Certificate as N/A
equivalent Per:
there to given N/A
by any
Institute
recognized by
the
Government.

Preferential Qualification Details

S No. Qualification Acquired

1 Served in the Territorial Army for a minimum period of two years or No

2 Has obtained National Cadet Corps B certificate No

↓ Address Details ↓

N C/O
Name , C/O:

House no./Village :

Street No./PO :

Locality/Kasba/City :

State / District Name :

Pin :

Permanent Address

163 Amaura Benirama,Po-Kalabahadurpur Sub District -Laharpur , District -Sitapur ,Uttar Pradesh PIN
CODE -261207
163 Amaura Benirama

Kalabahdurpur

Sub District Laharpur

UTTAR PRADESH / SITAPUR

261207

Correspondence/Mailing Address

163 Amaura Benirama,Po-Kalabahadurpur Sub District -Laharpur , District -Sitapur ,Uttar Pradesh PIN CODE
-261207
163 Amaura Benirama

Kalabahdurpur

Sub District Laharpur

UTTAR PRADESH / SITAPUR

261207

Declaration

✔ मैं एतद्द्वारा घोषणा करता/करती हूं कि मैंने विज्ञापन भलीभांति पढ़ लिया है और मैं इसके सभी
नियम और शर्तों को स्वीकार करता/करती हूं ।
I hereby declare that I have read the advertisement and I accept all the terms &
conditions of the same.
✔ मैं एतद्द्वारा घोषणा करता/करती हूं कि इस आवेदन में की गई सभी प्रविष्टियां/विवरण मेरी
जानकारी और विश्वास के अनुसार सत्य, पूर्ण और सही हैं।
I hereby declare that all the entries/statements made in this application are true,
complete and correct to the best of my knowledge and belief.
✔ मैं एतद्द्वारा घोषणा करता/करती हूं कि आवेदन की अंतिम तिथि तक मुख्य परीक्षा के लिए निर्धारित
सभी शैक्षणिक/अन्य पात्रता मानदंडों को पूरा करता/करती हूं । मै अवगत हूं कि मेरे द्वारा प्रस्तुत की गई
कोई भी जानकारी गलत/असत्य पाये जाने की दशा में मेरा अभ्यर्थन आयोग द्वारा निरस्त कर दिया
जाएगा ।
I hereby declare that I fulfil all the educational/ other eligibility criteria prescribed for
the Main Examination in respect of the post being applied for, as on the last date of
application. I am aware that in case any of the information submitted by me is found
to be incorrect or false, then my candidature shall be liable to be cancelled by the
Commission.
 Please login with your PET registration number to avail the Dashboard facility for all
activities of recruitment process.

Current status of application

Your application is under processing.
App. form submission date : DATE :30/09/2023 ,TIME :18:43:28
App. form printing Date & Time : [ 30/09/2023 ,7:09:46 PM ]
App. Modification Date & Time : 30/09/2023 18:59:12

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