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    Application Form

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    rpr1786

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    © All Rights Reserved
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    Application Form

    Uploaded by

    rpr1786
    4 views1 page

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    Copyright:

    © All Rights Reserved
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    Download as docx, pdf, or txt
    4 views1 page

    Application Form

    Uploaded by

    rpr1786

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    APPLICATION FORM

    1. Advertisement No. 04/AHJ/2024 Date: 30/11/2024


    2. Post applied for. JR, GAS PIPE LINE OPERATOR
    3. Name of Candidate. GOURAV RAINA
    4. Parentage. NISHA RAINA
    5. Date of Birth. 03/03/2001
    6. Category. GENERAL
    7. Address. NAI BASTI RANGPUR SADHREY R.S. PORA
    JAMMU, JAMMU AND KASHMIR PIN 181102. Space for
    District. Jammu Block R.S. Pora
    8. Contact No. 8492905351
    9. Details of Qualification:
    Examination Examining Body/ Year of Marks Total %age
    passed Board Passing obtained Marks
    10th JK BOSE 2020 197 500 39%
    10+2
    Above
    Marks of all semesters write below mentioned columns (Technical qualification
    required for adv. post)
    Examination Examining Body/ Board/ Year of Marks Total %age
    passed University Passing obtained Marks

    G. TOTAL:
    10. Date of completion of qualifying degree /diploma.18 Oct 2019
    11. Registration Certificate.201AB93F232A4B8AA121E3F3ACEF93EB
    12. Documents enclosed:
    a) Aadhaar card b) Marksheet
    c) Domicile certificate d) Passing certificate
    e) ITI Certificate f) Experience certificate
    13. I do hereby declare that
    a) The Statements made in this application are true to the best of my knowledge and
    belief.
    b) I have never been debarred from appearing in any examination/ Interview.
    c) I have never been arrested / prosecuted or 'Involved In any criminal case
    registered by the police or convicted by the criminal court.
    d) I have undergone the degree from university head-quarters and not from the
    off-campuses which have been established by these Universities beyond their
    territorial Jurisdiction (In case of Distance Mode).
    e) I undertake that any willful concealment of the facts shall result in the
    cancellation of my candidature and the State Health Society may also debar
    me from applying for future selection.
    I shall accept the selection made by the selection committee which will be binding on me.
    Ends:

    Signature of the applicant

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