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    Bulu Document

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    sagariaeleven
    The document contains an application form submitted by Bichitra Bhoi for the Multi Tasking (Non-Technical) Staff, and Havaldar (CBIC & CBN) Examination, 2023 conducted by the Staff Selection Commission. The form provides Bichitra Bhoi's personal details like name, father's name, date of birth, address, education qualifications, preferences for examination centers, declaration of truthfulness of information provided in the application.

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    © All Rights Reserved
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    Bulu Document

    Uploaded by

    sagariaeleven
    42 views4 pages
    The document contains an application form submitted by Bichitra Bhoi for the Multi Tasking (Non-Technical) Staff, and Havaldar (CBIC & CBN) Examination, 2023 conducted by the Staff Selection Commission. The form provides Bichitra Bhoi's personal details like name, father's name, date of birth, address, education qualifications, preferences for examination centers, declaration of truthfulness of information provided in the application.

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    The document contains an application form submitted by Bichitra Bhoi for the Multi Tasking (Non-Technical) Staff, and Havaldar (CBIC & CBN) Examination, 2023 conducted by the Staff Selection Commission. The form provides Bichitra Bhoi's personal details like name, father's name, date of birth, address, education qualifications, preferences for examination centers, declaration of truthfulness of information provided in the application.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    42 views4 pages

    Bulu Document

    Uploaded by

    sagariaeleven
    The document contains an application form submitted by Bichitra Bhoi for the Multi Tasking (Non-Technical) Staff, and Havaldar (CBIC & CBN) Examination, 2023 conducted by the Staff Selection Commission. The form provides Bichitra Bhoi's personal details like name, father's name, date of birth, address, education qualifications, preferences for examination centers, declaration of truthfulness of information provided in the application.

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    STAFF SELECTION COMMISSION

    BLOCK NO. 12, CGO COMPLEX, LODHI ROAD,


    NEW DELHI 110003
    MULTI TASKING (NON-TECHNICAL) STAFF, AND
    HAVALDAR (CBIC & CBN) EXAMINATION, 2023
    REGISTRATION NO: 40006639623
    APPLICATION RECEIVED (CONTENTS NOT VERIFIED)
    1. NAME AS PER MATRICULATION 2. NEW/CHANGED
    CERTIFICATE 3. FATHER'S NAME 4. MOTHER'S NAME
    NAME
    BICHITRA BHOI - VIRAKISHOR BHOI SATYABHAMA BHOI
    6. AGE AS ON
    5. DATE OF BIRTH (DD/MM/YYYY) 7. GENDER 8. CATEGORY
    01/08/2023
    21/03/2005 18.4 MALE ST
    9. WHETHER PERSON WITH DISABILITY (PwD)? 9.1 IF YES, TYPE OF DISABILITY
    NO -
    10. NATIONALITY 11. MARK OF VISIBLE IDENTIFICATION
    CITIZEN OF INDIA NO
    13. MATRICULATION (10th 14. MATRICULATION (10th
    12. MATRICULATION (10th CLASS) EXAMINATION BOARD
    CLASS) ROLL NO CLASS) YEAR OF PASSING
    BOARD OF SECONDARY EDUCATION, ODISHA 108EG0080 2020
    15. PREFERENCE OF EXAMINATION CENTERS
    EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER
    ( FIRST PREFERENCE ) ( SECOND PREFERENCE ) ( THIRD PREFERENCE )
    BHUBANESHWAR ( 4604 ) SAMBALPUR ( 4609 ) ROURKELA ( 4610 )

    16. MEDIUM FOR COMPUTER BASED EXAMINATION(CBE)

    ORIYA (16)
    17.1. WHETHER YOU ARE AN EX- 17.3.DATE OF DISCHARGE/ LIKELY DATE
    17.2. DATE OF JOINING THE ARMED
    SERVICEMAN (ESM) OR SERVING OF DISCHARGE FROM ARMED FORCES
    FORCES (DD/MM/YYYY)
    IN THE ARMED FORCES? (DD/MM/ YYYY)
    NO - -
    17.5. HAVE YOU ALREADY JOINED A
    17.4. LENGTH OF SERVICE IN THE CIVIL POST BY AVAILING BENEFIT OF 17.6. DATE OF JOINING TO CIVIL POST
    ARMED FORCES RESERVATION FOR EX-SERVICEMAN (DD/MM/YYYY)
    (ESM) ?
    - - -
    18.1. ARE YOU A PERSON WITH BENCHMARK DISABILITIES (40% OR MORE) IN THE CATEGORY OF BLINDNESS (VH)?:
    -
    18.2. ARE YOU A PERSON WITH BENCHMARK DISABILITIES (40% OR MORE) IN THE CATEGORY OF OH- BOTH ARMS
    AFFECTED (OH-BA) OR OH- CEREBRAL PALSY (OH-CP)?:
    -
    18.3. Do you have a physical limitation to write as per Para 8.2 or 8.3 of the Notice (Certificate to this effect from competent authority as
    per format at Annexure-I/ Annexure-IA to the Notice of Examination, would be required at the time of Examination.)? :
    -
    18.4 WHETHER SCRIBE IS REQUIRED 18.5 WILL YOU MAKE YOUR OWN 18.6 IF SCRIBE IS TO BE
    ARRANGEMENT OF SCRIBE? ARRANGED BY SSC, INDICATE
    MEDIUM
    - - -
    19.1. WHETHER SEEKING AGE RELAXATION? 19.2. IF YES,INDICATE CODE
    NO -
    20. STATE(S) / U.T.(S) / CCA(S) PREFERENCE CODE
    32,26,28,54,56,57,72,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,
    X,X,X,X,X,X,X
    21. HIGHEST EDUCATIONAL QUALIFICATION
    INTERMEDIATE/ HIGHER SECONDARY/ 10+2 (2)
    22. DETAILS OF QUALIFYING EDUCATION
    10TH STANDARD
    STATUS PASSING STATE/ UT OF BOARD/ NAME OF BOARD/ ROLL NO PERCENTAGE CGPA
    YEAR UNIVERSITY UNIVERSITY
    PASSED 2020 ODISHA BOARD OF 108EG0080 43.33 -
    SECONDARY
    EDUCATION, ODISHA
    23. 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
    ADDRESS DETAIL
    24. CORRESPONDENCE ADDRESS 25. PERMANENT ADDRESS
    AT- KHUTUNAPANI PO- BANAIMUNDA VIA-PATNAGARH AT- KHUTUNAPANI PO- BANAIMUNDA VIA-PATNAGARH
    DISTRICT: BALANGIR DISTRICT: BALANGIR
    STATE: ODISHA STATE: ODISHA
    PIN: 767025 PIN: 767025
    MOBILE NO. : 9348364703 EMAIL ID: bhoib0262@gmail.com
    26. WHETHER THE PHOTOGRAPH HAS BEEN TAKEN ON OR AFTER 21-APR-2023?

    YES
    FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
    EXEMPTED - - -
    DECLARATION
    1. I HAVE READ THE NOTICE OF THE EXAMINATION AND ACCEPT ALL THE TERMS & CONDITIONS OF THE
    NOTICE OF THE EXAMINATION.

    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.

    3. I DECLARE THAT THE PHOTOGRAPH UPLOADED IN THE APPLICATION FORM HAS BEEN TAKEN ON OR
    AFTER THE STIPULATED DATED.

    4. I AGREE TO AUTHORIZE SSC TO USE MY AADHAR DATA FOR VERIFICATION PURPOSE.


    PRINT TAKEN ON: 15/07/2023 2:36:42 PM IP ADDRESS: 152.58.143.81
    NUMBER OF ATTEMPT: 1

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