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Staff Selection Commission: Combined Graduate Level Examination, 2019

1) The document is an application form for Srishti Pathak to take the Combined Graduate Level Examination in 2019. 2) It provides her personal details like name, date of birth, gender, category, address, education qualifications, and preference of examination centers. 3) Srishti declares that all the information provided in the application is true and she is willing to serve anywhere in India if selected.

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Uttkarsh Singh
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© © All Rights Reserved
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59 views

Staff Selection Commission: Combined Graduate Level Examination, 2019

1) The document is an application form for Srishti Pathak to take the Combined Graduate Level Examination in 2019. 2) It provides her personal details like name, date of birth, gender, category, address, education qualifications, and preference of examination centers. 3) Srishti declares that all the information provided in the application is true and she is willing to serve anywhere in India if selected.

Uploaded by

Uttkarsh Singh
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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STAFF SELECTION COMMISSION

BLOCK NO. 12, CGO-COMPLEX, LODHI ROAD, NEW DELHI


110003

COMBINED GRADUATE LEVEL EXAMINATION, 2019

REGISTRATION NO: 30000915696

APPLICATION IS PROVISIONALLY ACCEPTED

1. NAME AS PER 2. NEW/ CHANGED 3. FATHER'S NAME 4. MOTHER'S NAME


MATRICULATION CERTIFICATE NAME

SRISHTI PATHAK - OM PRAKASH PATHAK SHILYU KUMARI PATHAK


6. AGE AS ON
5. DATE OF BIRTH (DD/MM/YYYY) 7. GENDER 8. CATEGORY
01/01/2020
05/01/1997 22.11 FEMALE UNRESERVED
9. WHETHER PERSON WITH DISABILITY (PWD) ? 9.1 IF YES, TYPE OF DISABILITY (OH, HH,VH, OTHERS)

NO -

10. NATIONALITY 11. MARK OF VISIBLE IDENTIFICATION


CITIZEN OF INDIA NOTHING
12. MATRICULATION (10th CLASS) EXAMINATION 13. MATRICULATION (10th 14. MATRICULATION (10th
BOARD CLASS) ROLL NO CLASS) YEAR OF PASSING
BOARD OF HIGH SCHOOL AND INTERMEDIATE
1583345 2012
EDUCATION UTTAR PRADESH
15. DO YOU BELONG TO ECONOMICALLY WEAKER SECTION (EWS) ?
NO
16. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER
(FIRST PRFERENCE ) (SECOND PREFERENCE ) (THIRD PREFERENCE )
DELHI ( 2201 ) AJMER ( 2401 ) JAIPUR ( 2405 )
17.1. HAVE YOU ALREADY
JOINED A CIVIL POST BY 17.3. DATE OF DISCHARGE
17.WHETHER EX- 17.2. LENGTH OF SERVICE IN
AVAILING BENEFIT OF FROM ARMED FORCES
SERVICEMAN (ESM) ? ARMED FORCES ( IN YEARS )
RESERVATION FOR EX- (DD/MM/YYYY)
SERVICEMAN (ESM) ?
NO - - -
18. WHETHER SUFFERING FROM CEREBRAL-PALSY ?
-
18.1. 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) ?
-
18.2. WHETHER SCRIBE IS REQUIRED ? 18.3. WILL YOU MAKE YOUR OWN 18.4. IF SCRIBE IS TO BE ARRANGED
ARRANGEMENT OF SCRIBE ? BY SSC, INDICATE MEDIUM
- - -
19. ARE YOU ALSO APPLYING FOR THE POST OF JUNIOR 20. DO YOU POSSESS EQ FOR THE POST OF JUNIOR
STATISTICAL OFFICER (MoSPI)? STATISTICAL OFFICER (MoSPI)?
NO -
21. ARE YOU ALSO APPLYING FOR THE POST OF 22. DO YOU POSSESS EQ FOR THE POST OF STATISTICAL
STATISTICAL INVESTIGATOR GRADE II (RGI) ? INVESTIGATOR GRADE II (RGI) ?
NO -
23. WHETHER SEEKING AGE RELAXATION ? 23.1 IF YES, AGE RELAXATION CODE
NO -
25. DO YOU WANT TO MAKE AVAILABLE YOUR
PERSONAL INFORMATION FOR ACCESSING JOB
24. QUALIFICATION DETAILS OPPORTUNITY IN TERMS OF DoP&T'S O.M
NO.39020/1/2016-ESTT.(B) DATED 21.06.2016 ?

M. SC. (27) YES

ADDRESS DETAIL
26. CORRESPONDENCE ADDRESS 27. PERMANENT ADDRESS
12A/5 MAHARANA PRATAP ROAD BLOCK 12A KAROL LIG299 MAHARSHI DAYANAND VIHAR PHASE 2
BAGH NEW DELHI KALYANPUR
DISTRICT: NEW DELHI DISTRICT:KANPUR NAGAR
STATE: DELHI STATE: UTTAR PRADESH
PIN : 110005 PIN : 208026
MOBILE NO: 7905840577 EMAIL: [email protected]
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
EXEMPTED - - -
DECLARATION
1. I HAVE READ THE NOTICE OF EXAMINATION AND ACCEPT ALL THE TERMS & CONDITIONS
MENTIONED THEREIN.

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: 21/11/2019 1:44:19 PM

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