Form SSC Print PDF
Form SSC Print PDF
Form SSC Print PDF
1. CANDIDATE'S NAME (AS 3. FATHER'S NAME (AS PER 4. MOTHER'S NAME (AS
PER THE MATRICULATION 2. NEW/ CHANGED NAME THE MATRICULATION PER THE MATRICULATION
CERTIFICATE) CERTIFICATE) CERTIFICATE)
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21.1. WHETHER SUFFERING FROM CEREBRAL-PALSY ?
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21.2. DO YOU HAVE A PHYSICAL LIMITATION TO WRITE AND SCRIBE IS REQUIRED TO WRITE ON YOUR BEHALF
(CERTIFICATE TO THIS EFFECT FROM THE CHIEF MEDICAL OFFICER/ CIVIL SURGEON & MEDICAL
SUPERINTENDENT OF A GOVERNMENT HEALTH CARE INSTITUTION AS PER NOTICE OF THE EXAMINATION
WOULD BE REQUIRED AT THE TIME OF EXAMINATION) ?
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21.3. WHETHER SCRIBE IS 21.4. WILL YOU MAKE YOUR OWN 21.5. IF SCRIBE IS TO BE ARRANGED BY SSC,
REQUIRED ? ARRANGEMENT OF SCRIBE ? INDICATE MEDIUM
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22. WHETHER SKILL TEST REQUIRED?: 23. LANGUAGE/ MEDIUM OF SKILL TEST
NO ENGLISH
24. WHETHER SEEKING AGE RELAXATION ? 24.1 IF YES, AGE RELAXATION CODE
YES 01-SC/ST
DETAILS OF WORK EXPERIENCE
S.NO. NAME OF ORGANIZATION(S) DESIGNATION NATURE OF DUTY PERIOD OF PERIOD OF
SERVICE FROM SERICE TO
(DD/MM/YYYY) (DD/MM/YYYY)
1 MECHANICAL ENGINEER ALWAR NIET COLLEGE 26/07/2018 20/02/2020
25. HIGHEST EDUCATIONAL QUALIFICATION FOR THE 26. SUBJECT
POST OF INTEREST
(I) 12TH STANDARD PASS IN SCIENCE STREAM WITH SCIENCE
MATHEMATICS AS A SUBJECT FROM A RECOGNIZED
BOARD OR EQUIVALENT. (II) A SPEED OF NOT LESS
THAN 15000 KEY DEPRESSIONS PER HOUR FOR DATA
ENTRY WORK TO BE ASCERTAINED THROUGH SPEED
TEST ON COMPUTER.
28. DO YOU WANT TO MAKE AVAILABLE YOUR
27. DO YOU BELONG TO ECONOMICALLY WEAKER PERSONAL INFORMATION FOR ACCESSING JOB
SECTION (EWS)? OPPORTUNITY IN TERMS OF DoP&T'S O.M
NO.39020/1/2016-ESTT.(B) DATED 21.06.2016 ?
- NO
ADDRESS DETAIL
29. CORRESPONDENCE ADDRESS 30. PERMANENT ADDRESS
DURGAMATA MANDIR VALI GALI POST TAPUKARA DURGAMATA MANDIR VALI GALI POST TAPUKARA
TEH TIJARA DISTT ALWAR RAJ TEH TIJARA DISTT ALWAR RAJ
DISTRICT: ALWAR DISTRICT: ALWAR
STATE: RAJASTHAN STATE: RAJASTHAN
PIN 301707 PIN: 301707
MOBILE NO : 9680636731 EMAIL: chaudinesh32@gmail.com
2. 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.I AM WILLING TO SERVE ANYWHERE IN INDIA.
PRINT TAKEN ON: 26/02/2020 4:56:42 PM