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    DECT84754

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    DECT84754

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    DECT84754

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    madhurjyap
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    GOVERNMENT OF ASSAM

    STATE LEVEL POLICE RECRUITMENT BOARD, ASSAM


    REHABARI::: GUWAHATI

    (NO APPLICATION FEE IS APPLICABLE)

    APPLICATION FORM
    SLPRB/ REC/GRADE-III& IV/ ECT/2020/ APPLY DATE: 10-10-2020

    APPLICATION NO. NAME: DATE OF BIRTH:


    DECT84754 MAYURI KONWAR 30-06-1985

    FATHERS' NAME: MOTHERS' NAME: CASTE:


    KARMADHAR PHUKAN SWAPNA PHUKAN OBC/MOBC

    EMAIL: PHONE: ADD. PHONE: GENDER:


    NA 7002734839 9864444133 FEMALE

    NATIONALITY: RELIGION: EMPLOYMENT NO. :


    INDIAN HINDU 579/2016

    POST APPLIED FOR


    JUNIOR ASSISTANT (ZONE LEVEL EMPLOYMENT EXCHANGES) (PREFERENCE 1)
    JUNIOR ASSISTANT (HQ) (PREFERENCE 2)

    PERMANENT ADDRESS CORRESPONDENCE ADDRESS

    1 NO. KAKOJAN KONWAR GAON, P.O. DHITAI PUKHURI 1 NO. KAKOJAN KONWAR GAON, P.O. DHITAI PUKHURI

    DISTRICT: POLICE STATION: PIN: DISTRICT: POLIOCE STATION: PIN:


    SIVASAGAR SIVASAGAR 785685 SIVASAGAR SIVASAGAR 785685

    ACAMEDIC QUALIFICATION

    COLLEGE / SCHOOL NAME: QUALIFICATION: DEPARTMENT: SUBJECT SELECTED PERCENTAGE:


    PATSAKU COLLEGE GRADUATE BA NA 47 %

    EXTRA CURRICULAR ACTIVITIES

    COMPUTER
    EX-SERVICEMAN
    PROFICIENCY PWD CERTIFICATE PWD CATEGORY PWD CATEGORY PERCENTAGE
    CERTIFICATE
    CERTIFICATE
    NA NA NA
    NA
    YES

    EWS CERTIFICATE EMPLOYMENT EX CERTIFICATE


    NA YES

    CERTIFICATES

    Certificate Name Option Certificate Name Option

    ZONE SELECTED FOR JUNIOR ASSISTANT (ZONE LEVEL EMPLOYMENT


    GRADE IV ZONE LEVEL
    EXCHANGES)
    NA
    DIBRUGARH ZONE:(DZ)

    DECLARATION:
    It is certified that above particulars are true to my knowledge and belief. Further, I understand that if any of the above particulars is found false, my candidature will be automatically
    rejected.

    NOTICE:
    Candidate should check all the data entered in the application form very carefully. Any issue noticed, candidate may contact recruitment Help Desk Tel: 7636071991, 7636071992, 7636071993 (09:00am - 06:00pm) or Email:
    slprbrect@gmail.com.

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