Ssc Mts.pdf 4t3t65

1/10/2017

164.100.129.99/mts/pdfprint/print.jsp

Application Registration No: 63005096460 for the Multi Tasking(Non - Technical) Staff In Different States/ UTs, 2016 Your Application is Completed CR-Varanasi(3013) 1.& 1.1. Name of Center and Center Code : CR-Allahabad(3003) CR-Lucknow(3010) 2.Candidate Name :

RAJNISH KUMAR RAM

3.Father's Name :

RAM KUMAR RAM

4.Mother's Name :

LEELA DEVI

5.Date of Birth (dd/mm/yyyy) :

04/05/1998

6. Age(as on 01.08.2017) :

19.3

7. Nationality :

Indian

8.Gender :

Male

9.Category :

SC

10. Whether PH (PWD) :

No

10. If yes, indicate code : No

10.1. Whether Ex-Serviceman? : 10.2. For Ex-Serviceman-Length of Service(in years) : 10.2. Date of discharge (dd/mm/yyyy) :

No

11. Whether seeking Age relaxation? : 11.1. If yes, indicate code : 12. Whether suffering from cerebral palsy? : 12. If VH/Cerebal Palsy candidate, whether scribe is required ? 13. if yes indicate medium : 14. Whether you belong to Religious Minority Community ? :

No

15. Aadhar Card Number (If available):

237559280754

16.Mark of Visible Identification :

A CUT MARK ON LEFT EYEBROW

17. State/UT Code :

IJY234FEDCABGHKLMNOPQRSTUVWZ15678

18. Educational Qualification :

12th

19. Details of Work Experience : Name of the organisation

Designation

Nature of Duty(ies)

Period of Period of Service Service From(mm/yyyy) To(mm/yyyy)

20.Postal Address :

VILAGE - KAKODHA POST - KAKODHA THANA - SAKATPUR DISTRICT DARBHANGA

Village/City :

KAKODHA

District :

DARBHANGA

State :

Bihar

Pincode :

847204

21.Permanent/Domicile Address :

VILAGE - KAKODHA POST - KAKODHA THANA - SAKATPUR DISTRICT DARBHANGA

State :

Bihar

Pincode :

847204

STD Code : Phone Number : Mobile Number :

9118910330

Email ID :

[email protected] 22.Photo

23.Signature

Declaration

I hereby declare that all the statements made in this application are true, complete and correct to the best of my knowledge and belief. I understand that in the event of any information being found suppressed false or incorrect or ineligibility being detected before and after examination, my candidature/appointment is liable to be cancelled. Place: Date (yyyy-mm-dd):2017-01-10 Signature of Candidate

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