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Staff Selection Commission

(Block No. 12, CGO-Complex, Lodhi Road, New Delhi


110003 )
Combined Graduate Level Examination-2017
Registration No: 64006803007

Application Status: Application provisionally submitted

Name of the Examination Centre Examination Centre Code


SR-Coimbatore(8202) 8202
SR-Tiruchirapalli(8206) 8206
SR-Madurai(8204) 8204
Candidate's Full Name Father's Name Mother's Name Date of Birth
HELENA NANCY D DAVID ADAIKALA RAJ P NINO GRACE D 1994-10-18
Gender Nationality Fee Category
Female Indian Fee Exempted OBC
Whether Ex-serviceman If,ExS,whether seeking Length of Service Date of Discharge
reservation?
No
Whether PH? If yes,indicate code Whether seeking Age If yes,indicate code Age as on (01.08.2017)
relaxation?
No No 22.9
Preference for Group of Are you applying for the Do you possess EQ for the Are you applying for the Do you possess EQ for the
Posts: Posts of Junior Statistical Posts of Junior Statistical Post of AAO? Posts of AAO?
Officer? Officer?
BCDA No No No No
Whether belong to Minority If VH/Celebral Palsy/Locomotor If yes,indicate medium Mark of visible identification
Communities as per Govt. Orders? candidate,whether scribe is
required?
Yes No A SCAR ON THE RIGHT HAND
NEAR WRIST
Mode of Fee Payment Amount Transaction-ID Transaction Date

Educational Qualiication(Please note that possession of Graduate Qualification is a pre-requisite to apply for this examination,However you may
indicate your highest qualification) Indicate Code
BE

Do you want to make available your personal information for accessing job opportunity in terms of Dop&T's O.M
No.39020/1/2016-Estt.(B) dated 21.06.2016?
Yes

Details of Work Experience/Govt. Service rendered


Name of the Organization Designation Nature of Duty(ies) Period of Service
PAYODA TECHNOLOGIES SOFTWARE ENGINEER III APPLICATION DEVELOPER 06/2016-12/2018

Address Detail
Communication Address Permanent Address
63/1 FIRST FLOOR MAHESHWARI NAGAR FIRST STREET 63/1 FIRST FLOOR MAHESHWARI NAGAR FIRST STREET
EXTENSION THANEERPANDAL EXTENSION THANEERPANDAL PEELAMEDU COIMBATORE
City: PEELAMEDU State: Tamil Nadu
District: COIMBATORE Pin Code: 641004
State: Tamil Nadu Mobile No.: 7708577391
Pin Code: 641004 Email Id: dhelenanancy@gmail.com
Declaration
I hereby declare that all 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 or after the examination, my candidature/appointment is liable to be cancelled

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