Odisha Sub-ordinate Staff Selection Commission (OSSSC) Page 1

19 Feb 2024
Copy of the Provisional Application submitted online for the Post of
Combined Recruitment Examination(IV)-2023 for the district cadre posts of

FS t
d S tric
RI, Supervisor (ICDS), ARI, Amin and SFS - 2023
Advertisement Details

an is
Advertisement No. & : IIE-60/2023-938(C)/OSSSC Recruitment Year : 2023

in e d
Date
Advertisement Date : 29/12/2023

Am r th
Registration and Application Details
Applied to : Odisha Sub-ordinate Staff Selection Commission (OSSSC)

RE 024 ARI, 23 fo
Application Number : GN93823CRE4-00031731
Application Initiation Date : 19/02/2024 08:08:01
& Time
Application Submission : 19/02/2024 08:41:02

1
Date & Time

82 /02 S), -20

73
Registration Number : 01591026
Registered User Name :
93 (19 CD (IV) Karku2024

31
Email Id : hitash431@gmail.com

4-0 )
Mobile No. : 9692681530

00
GN - r (I on

Alternate Mobile No. : 9668024192

Alternate Email Id : beherahitash4@gmail.com
26 SC so ati

3C /2
Post Applied : Combined Recruitment Examination(IV)-2023 for the district cadre
posts of RI, Supervisor (ICDS), ARI, Amin and SFS
10 SS rvi in

Posts/ Services applied, : 1) AMIN ( AMIN )

in order of personal
59 O upe xam

2) ASSISTANT REVENUE INSPECTOR ( ARI )

Preference(s)
3) STATISTICAL FIELD SURVEYOR ( SFS )
4) SUPERVISOR ( SUP )
,S tE

5) REVENUE INSPECTOR ( RI )
Cadre : DISTRICT CADRE GROUP-B
RI en

Select the District : 1) GANJAM

wherein you want to
of itm

appear in the
Recruitment Examination.
Essential Compliance Details
sts cru

Restrictions, if any, imposed by any Recruitment Commissions/Boards

Have you been debarred from appearing the recruitment examination of any : NO
po Re

Commission/Board?
Odia Language Knowledge
dre ined

Can you speak, read & write : Can Speak Odia, Read Odia & Write Odia
01

Odia?
Odia Language Passing : Passed Matriculation or equivalent Examination with Odia as the medium of examination in
Standard non-language subjects
mb

Personal Details
Name of the Applicant : KARKU PUSHPANJALI
Co
ca

Father's Name : KARKU TATEYA

Mother's Name : KARKU KANTAMMA
Gender : FEMALE
Date of Birth : 21/01/1992
Age : 30 Years 11 Months 11 Days
Category applied : SOCIALLY EDUCATIONALLY BACKWARD CLASS ( SEBC (W) )
Sub-category of the : Nolia
applied Category
 Odisha Sub-ordinate Staff Selection Commission (OSSSC) Page 2
19 Feb 2024
Copy of the Provisional Application submitted online for the Post of
Combined Recruitment Examination(IV)-2023 for the district cadre posts of

FS t
d S tric
RI, Supervisor (ICDS), ARI, Amin and SFS - 2023
Nationality : INDIAN

an is
Religion : HINDUISM

in e d
Personal Identificantion : Black mole on neck
Mark

Am r th
Marital Status : UNMARRIED
Have any of your family members been working in the Odisha Sub-ordinate Staff : NO
Selection Commission (OSSSC) ?

RE 024 ARI, 23 fo
Address Details
Permanent Address AT HARIPUR, PO GOPALPUR, PS CHAMAKHANDI, TASHIL CHHATRAPUR, City/Town -
GOPALPUR, Post Office - GOPALPUR, Police Station - CHAMAKHNADI, CHHATRAPUR
TAHASIL, GANJAM, ODISHA , Pincode - 761002

1
82 /02 S), -20
AT HARIPUR, PO GOPALPUR, PS CHAMAKHANDI, TASHIL CHHATRAPUR City/Town -

73
Address for
GOPALPUR, Post Office - GOPALPUR, Police Station - CHAMAKHNADI, CHHATRAPUR
Communication TAHASIL, GANJAM, ODISHA, Pincode - 761002
93 (19 CD (IV)

31
Alternate Mobile No.9668024192

4-0 )
00
Education Details
GN - r (I on

Qualification Passing Board/ Council/ Secured Mark Total Mark Percentage Grade Passing
Year University /Examination (without extra (without extra (without extra Attempt
Conducting Body optional) optional) optional)
26 SC so ati

3C /2
10th (HSCE) or equivalent
10 SS rvi in

10th (HSCE) 2010 GOVT U G HIGH 350 600 58.33333% --

SCHOOL , KALIPALLI
59 O upe xam

,GOPALPUR

BOARD OF
SECONDARY
,S tE

EDUCATION, ODISHA

CR. No.A210-012092
RI en

MS. No.0583536
+2 (HSE) or equivalent
of itm

+2 (HSEC) 2022 Ramadhin Sanskrit 282 500 56.40000% --

(SANSKRIT) College
sts cru

SHRI JAGGANATH
SANSKRIT VIDALYA
po Re

CR. No.2004GM024
MS. No.U04GM024/20
Do you have Knowledge of Computer Skill? : YES
dre ined

01

++3 (Bachelor) degree or equivalen

***I do not ha - -
mb

Document Details
Document Name Misc./Document No. Issuing Date Issuing Authority
Co
ca

10th (HSCE) OR EQIVALENT CERTIFICATE A210-012092 10/05/2011 BOARD OF SECONDARY

EDUCATION, ODISHA

ADHAAR CARD/ADHAAR ENROLEMENT NO 57xxxxxxxx15 UNIQUE IDENTIFICATION

AUTHORITY OF INDIA

CASTE CERTIFICATE E-OBC/2021/137045 06/08/2021 CHHATRAPUR TAHASIL

 Odisha Sub-ordinate Staff Selection Commission (OSSSC) Page 3
19 Feb 2024
Copy of the Provisional Application submitted online for the Post of
Combined Recruitment Examination(IV)-2023 for the district cadre posts of

FS t
d S tric
RI, Supervisor (ICDS), ARI, Amin and SFS - 2023
Self Declaration

an is
I, Karku Pushpanjali, Daughter of Karku Tateya, Age 32 Years 0 months 29 days, Caste Socially Educationally Backward

in e d
Class Resident of Village/Street/Lane ---------, P.O. Gopalpur, P.S Chamakhnadi, Town (NAC/Municipal Corporation)
Gopalpur, Tahasil Chhatrapur Tahasil, Ganjam, Odisha, PIN Code 761002, do hereby declare that the information given
above is true to the best of my knowledge and belief. I am well aware of the fact that if the information given by me is

Am r th
proved false/not true, I will be liable for action as per law and all the benefits, if any, availed by me shall be summarily
withdrawn.
Undertaking

RE 024 ARI, 23 fo
I do here by solemnly declare that I have carefully gone through the Recruitment Advertisement of the Commission and I
fulfill all the conditions of eligibility prescribed for admission to the examination. I also declare that all the statements made
in the application are true, complete and correct to best of my knowledge and belief. Copies of the documents uploaded by
me are genuine and relevant. I undertake that in case any such information or uploaded document is found to be incorrect,

1
false or irrelevant during or after the selection of candidate, my candidature/selection for the post will be cancelled and I

82 /02 S), -20

shall be liable to penal action as per law.

73
93 (19 CD (IV)

31
I Accept the Terms and Conditions.

4-0 )
00
GN - r (I on

Uploaded Signature of the Applicant

26 SC so ati

3C /2
.
Note :
10 SS rvi in

1) This is a computer report generated through OSSSC portal (www.osssc.gov.in) and does not require
59 O upe xam

any seal and signature of the issuing authority.

,S tE
RI en
of itm
sts cru
po Re
dre ined

01
mb
Co
ca