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Application Form Draft Print For All

The document is an application from Chadaram Jagadish for the Junior Engineer (Civil, Mechanical, Electrical and Quantity Surveying & Contracts) Examination, 2020 which provides his personal details such as name, father's name, date of birth, address, education qualifications. However, the application is marked as incomplete as the application fee has not been paid.

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Chadaram Jagadish
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47 views2 pages

Application Form Draft Print For All

The document is an application from Chadaram Jagadish for the Junior Engineer (Civil, Mechanical, Electrical and Quantity Surveying & Contracts) Examination, 2020 which provides his personal details such as name, father's name, date of birth, address, education qualifications. However, the application is marked as incomplete as the application fee has not been paid.

Uploaded by

Chadaram Jagadish
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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
JUNIOR ENGINEER (CIVIL, MECHANICAL,
ELECTRICAL AND QUANTITY SURVEYING &
CONTRACTS) EXAMINATION, 2020
REGISTRATION NO: 10002105007

APPLICATION IS INCOMPLETE
1. NAME AS PER MATRICULATION 2. NEW/ CHANGED 3. FATHER'S NAME 4. MOTHER'S NAME
CERTIFICATE NAME
CHADARAM
CHADARAM JAGADISH - CHADARAM LAXMI
JAGANNADHARAO
6. AGE AS ON
5. DATE OF BIRTH (DD/MM/YYYY) 7. GENDER 8. CATEGORY
01/01/2021
10/02/2001 19.1 MALE OBC
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 A MOLE ON NEAR LEFT HAND LITTLE FINGER
14. MATRICULATION
12. MATRICULATION (10th CLASS) EXAMINATION 13. MATRICULATION (10th
(10th CLASS) YEAR OF
BOARD CLASS) ROLL NO
PASSING
BOARD OF SECONDARY EDUCATION ANDHRA
1639133648 2016
PRADESH
15. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER ( FIRST ) EXAMINATION CENTER ( SECOND ) EXAMINATION CENTER ( THIRD )

VIJAYWADA ( 8008 ) RAJAHMUNDRY ( 8004 ) KAKINADA ( 8009 )


16.WHETHER EX- 16.1. DATE OF DISCHARGE 16.2. HAVE YOU ALREADY JOINED A CIVIL POST BY
SERVICEMAN (ESM) ? FROM ARMED FORCES AVAILING BENEFIT OF RESERVATION FOR EX-
(DD/MM/YYYY) SERVICEMAN (ESM) ?
NO - -
16.4. LENGTH OF SERVICE IN ARMED FORCES
16.3. DATE OF JOINING THE CIVIL POST (DD/MM/YYYY)
( IN YEARS )
- -
17. WHETHER SUFFERING FROM CEREBRAL PALSY ?
-
17. 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) ?
-
17.2 WHETHER SCRIBE IS REQUIRED ? 17.3 WILL YOU MAKE YOUR OWN 17.4 IF SCRIBE IS TO BE ARRANGED
ARRANGEMENT OF SCRIBE ? BY SSC, INDICATE MEDIUM
- - -
18. WHETHER SEEKING AGE RELAXATION ? 18.1 IF YES,INDICATE CODE
NO -
19. POST(S) APPLYING FOR
JE- MECHANICAL ENGINEERING
20. QUALIFICATION DETAILS
QUALIFYING DIPLOMA/ DEGREE SUBJECT/ STREAM

DIPLOMA (4) MECHANICAL ENGINEERING

UNIVERSITY/ BOARD ROLL NO YEAR OF PASSING PERCENTAGE CGPA


OTHERS 16545 2019 85.36 -
21. 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 ?
NO
ADDRESS DETAIL
22. POSTAL ADDRESS 23. PERMANENT ADDRESS
6-12 MALLA VEEDI KJ PURAM VILLAGE MADUGULA 6-12 MALLA VEEDI KJ PURAM VILLAGE MADUGULA
MANDAL VISHAKAPATNAM DISTRICT 531028 MANDAL VISHAKAPATNAM DISTRICT 531028
DISTRICT: VISAKHAPATNAM DISTRICT:VISAKHAPATNAM
STATE: ANDHRA PRADESH STATE: ANDHRA PRADESH
PIN : 531028 PIN : 531028
MOBILE NO: 8688167749 EMAIL: [email protected]
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
NOT EXEMPTED 100 - -
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.
PRINT TAKEN ON: 08/10/2020 7:26:46 PM IP ADDRESS:157.48.184.150

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