USER ID MHC20124507

APPLICATION NUMBER: 1834

PERSONAL DETAILS
2.1. NAME AS PER SCHOOL RECORD (IN CASE KARTHIKAI JOTHI P
OF NAME CHANGE, AS PER THE GAZETTED
NOTIFICATION)(IN CASE OF CANDIDATES NOT
POSSESSING ANY EDUCATIONAL
QUALIFICATION AND APPLYING FOR THE
POSTS OF SANITARY WORKER ETC, NAME AS
PER GOVERNMENT ISSUED DOCUMENT LIKE
AADHAAR, DRIVING LICENCE, PAN CARD
ETC..)AADHAAR
2.2. GENDER FEMALE
2.3. NATIONALITY (A)A CITIZEN OF INDIA
2.4. DATE OF BIRTH AS PER SCHOOL RECORD/ 03-JUN-1990
BIRTH CERTIFICATE
2.5. AGE AS ON 01.07.2021 31 YEARS 0 MONTHS 28 DAYS
2.6. EMAIL ID [email protected]
2.7. MOBILE NUMBER 6379580693
2.8. ARE YOU CLAIMING RESERVATION UNDER NO
PRIORITY CATEGORY?
2.9. ARE YOU CLAIMING RESERVATION UNDER NO
EX-SERVICEMEN?
2.10. ARE YOU CLAIMING RESERVATION NO
UNDER DESTITUTE WIDOW?
2.10(A). CERTIFICATE NUMBER
2.10(B). CERTIFICATE ISSUED BY
2.11. FATHER'S NAME PITCHAI
2.11(A). FATHER'S OCCUPATION(OCCUPATION SALAVAI THOZHIL
SHOULD BE MENTIONED EVEN IF DECEASED)
2.12. MOTHER'S NAME PETCHIYAMMAL
2.12(A). MOTHER'S OCCUPATION SALAVAI THOZHIL
2.13. MARITAL STATUS MARRIED
2.13(A). SPOUSE NAME MUTHURAJA
2.13(B). SPOUSE OCCUPATION SALAVAI THOZHIL
2.14. NATIVITY(ORIGIN) THENI
2.15. ARE YOU CLAIMING RESERVATION AS NO
DIFFERENTLY ABLED? (THE DISABILITY
SHOULD NOT BE LESS THAN 40%)
2.16. DO YOU HAVE COMMUNITY CERTIFICATE YES
ISSUED BY GOVERNMENT OF TAMIL NADU?
2.17. COMMUNITY MBC/DNC - MOST BACKWARD CLASSES/ DENOTIFIED COMMUNITIES
2.17(A). NAME OF THE SUB - CASTE VANNAR (SALAVAI THOZHILALAR) (INCLUDING AGASA, MADIVALA, EKALI, RAJAKULA,
VELUTHADAR AND RAJAKA) (EXCEPT IN KANNIYAKUMARI DISTRICT AND SHENCOTTAH
TALUK OF TIRUNELVELI DISTRICT WHERE THE COMMUNITY IS A SCHEDULED CASTE)
2.17(B). AUTHORITY WHO ISSUED HEADQUARTERS DEPUTY TAHSILDAR
CERTIFICATE
2.17(C). CERTIFICATE NUMBER 485435
2.17(D). DATE OF ISSUANCE OF CERTIFICATE 03-JUN-2000
2.18. RELIGION HINDU
2.19. HAVE BEEN SPONSORED BY THE YES
EMPLOYMENT EXCHANGE
2.19(A). DISTRICT COURT COMMUNICATION 204 2020
LETTER NUMBER
2.19(B). EMPLOYMENT EXCHANGE REGISTER THD2005F00006050
NUMBER

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2.20. ARE YOU ALREADY IN GOVERNMENT NO
SERVICE?(NOT AS TEMPORARY STAFF)
2.21. ARE YOU WORKING/WORKED IN THE YES
TAMIL NADU JUDICIAL MINISTERIAL
SERVICE(TNJMS)? AS TEMPORARY EMPLOYEE
UNDER RULE 16(A)(I) OF THE TAMIL NADU
JUDICIAL MINISTERIAL SERVICE RULES
2.21(A). STATUS PRESENTLY WORKING
2.21(B). NAME OF THE POST PRESENTLY OFFICE ASSISTANT
WORKING UNDER RULE 16(A)(I) OF THE
TAMILNADU JUDICIAL MINISTERIAL SERVICE
RULES
2.21(C). NAME OF THE COURT AND DISTRICT MUNSIF COURT UTHAMAPALAYAM THENI
2.21(D). DATE OF JOINING 04-JAN-2021
2.22. WHAT IS YOUR EDUCATION 8TH PASS TO 12TH FAIL
QUALIFICATION
2.24. ARE YOU AN OUTSTANDING SCOUT WHO NO
HAS RECEIVED AWARD FROM THE PRESIDENT
OF INDIA
2.25. ARE YOU EX- NCC CADETS? NO
2.26. ARE YOU A SERVING OR DISCHARGED NO
TEMPORARY GOVERNMENT EMPLOYEE
2.26(B). TOTAL PERIOD OF SERVICE,
INCLUDING BREAK UP PERIODS, IF ANY
YEARS 0
MONTHS 0
DAYS 0

PHOTO ID PROOF DETAILS

ADDRESS DETAILS
PERMANENT ADDRESS
2.28. ADDRESS LINE 1 28/2 INDIRA COLONY
2.28(A). ADDRESS LINE 2 CHINNAOVULAPURAM
2.28(B). STATE TAMIL NADU
2.28(C). DISTRICT THENI
2.28(D). CITY / VILLAGE CHINNAMANOOR
2.28(E). PINCODE 625515
CORRESPONDENCE ADDRESS
2.29. CORRESPONDENCE ADDRESS LINE 1 28/2 INDIRA COLONY
2.29(A). CORRESPONDENCE ADDRESS LINE 2 CHINNAOVULAPURAM
2.29(B). STATE TAMIL NADU
2.29(C). DISTRICT THENI
2.29(D). CITY / VILLAGE CHINNAMANOOR
2.29(E). PINCODE 625515

EDUCATIONAL QUALIFICATION

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 EDUCA DEGRE PERIOD DURAT NAME MONTH RECOGN PERCEN MEDIUM HAVE DATE MARK DO YOU SPECI PER
TIONAL E OF ION OF OF & IZED TAGE OF YOU OF SHEET HAVE ALIZA CENT
QUALIFI NAME STUDY STUDY BOARD YEAR UNIVER OF INSTRU STUD ISSUE NUMBE ANY TION AGE
CATION FROM (NO. / OF SITY MARKS CTION IED OF R/ OTHER OF
YYYY OF UNIVER PASSIN (YES / (%) TAMI CERTI CERTIFI BACHEL MAR
TO YEARS) SITY G NO) L AS FICAT CATE OR K
YYYY ONE E NUMBE DEGREE OBT
OF R OR PG AINE
THE DIPLOMA D
LAN ?/
GUA
GE
(PAR
T-1)
3. 08TH TAMIL MAY TAMIL YES
1. NADU 2003
STATE
BOAR
D
3. 10TH / TAMIL MAY 38.00 TAMIL YES 04- 137773
2. SSLC NADU 2005 JUN-
STATE 2005
BOAR
D

TECHNICAL QUALIFICATION
3.A.1. DO YOU KNOW TYPEWRITING? NO
3.A.2. DO YOU KNOW SHORTHAND? NO
3.A.3. ARE YOU HAVING ANY OTHER SKILLS? COOKING, GARDENING, HOUSEKEEPING

LANGUAGE PROFICIENCY
LANGUAGE TO READ TO WRITE TO SPEAK
3.B.1. TAMIL YES YES YES
3.B.2. ENGLISH YES YES YES
3.B.3. HINDI NO NO NO

ADDITIONAL INFORMATION
4.0. IS APPLICANTS BLOOD RELATIVES/ NO
FAMILY MEMBER WORKING IN MADRAS HIGH
COURT SERVICE OR TAMIL NADU JUDICIAL
SERVICE?
4.1. ARE YOU A TEMPORARY OR DISCHARGED NO
STATE GOVERNMENT EMPLOYEE DUE TO
REDUCTION IN ESTABLISHMENT OR FOR ANY
REASON BUT NOT AS A DISCIPLINARY
MEASURE?
4.2. HAVE YOU BEEN DEBARRED OR NO
DISQUALIFIED BY THE JUDICIAL
RECRUITMENT CELL, HIGH COURT, MADRAS
OR THE UNION PUBLIC SERVICE COMMISSION
OR ANY STATE PUBLIC SERVICE COMMISSION
OR ANY OTHER RECRUITING AGENCY, BOARD
OR COMMISSION, FROM APPEARING FOR
EXAMINATIONS/INTERVIEWS AND
SELECTIONS CONDUCTED BY IT,FOR A
SPECIFIC PERIOD OR PERMANENTLY?
4.3. WHETHER ANY DISCIPLINARY NO
PROCEEDINGS INITIATED OR PENALTY OR
PUNISHMENT HAS BEEN IMPOSED OR
CONTEMPLATED BY ANY DISCIPLINARY
AUTHORITY OR COURT, RENDERS HIM
UNSUITABLE FOR APPOINTMENT?
4.4. ARE YOU /WERE IN THE SERVICE OF NO
PUBLIC/PRIVATE SECTOR ORGANIZATION OR
LOCAL SELF-FINANCING INSTITUTION?

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4.5. HAVE YOU EVER BEEN ARRESTED/ NO
DETAINED/RELEASED ON BAIL/NAMED IN THE
FIR/CRIMINAL PROCEEDINGS PENDING/
COMPROMISED/QUASHED/REFERRED BY
POLICE/CHARGE SHEETED/PROSECUTED IN
ANY CRIMINAL CASE/PRIVATE
COMPLAINTANT/CONVICTED FOR
OFFENCE(INVOLVING MORAL TURPITUDE OR
ANY OTHER OFFENCE)
4.6. ARE YOU A MEMBER OF ANY POLITICAL NO
PARTY?
4.7. ARE YOU / WERE YOU CONTESTED IN ANY NO
ELECTION

UPLOAD DOCUMENTS
DOCUMENT FILE NAME
NAME
COMMUNITY MBC.PDF
CERTIFICATE
SSLC 10TH.PDF
CERTIFICATE

APPLIED POST DETAILS

DECLARATION

• I HEREBY DECLARE THAT ALL THE PARTICULARS FURNISHED IN THIS APPLICATION ARE TRUE, CORRECT AND COMPLETE TO THE BEST OF
MY KNOWLEDGE AND BELIEF. IN THE EVENT OF ANY INFORMATION BEING FOUND FALSE OR INCORRECT OR INELIGIBILITY BEING DETECTED
BEFORE OR AFTER THE EXAMINATION OR AT ANY STAGE, ANY ACTION CAN BE TAKEN AGAINST ME BY THE MADRAS HIGH COURT INCLUDING
REJECTION OF MY APPLICATION.
• I HEREBY DECLARE THAT I WILL NOT BE A PARTY TO ANY KIND OF CANVASSING ON MY BEHALF.
• I FURTHER DECLARE THAT I FULFILL ALL THE ELIGIBILITY CONDITIONS PRESCRIBED FOR ADMISSION TO THE EXAMINATION.
• I HAVE GONE THROUGH THE INSTRUCTIONS TO THE APPLICANTS AND THE MADRAS HIGH COURT'S NOTIFICATION FOR THIS RECRUITMENT
BEFORE FILLING UP THE APPLICATION FORM.
• I DECLARE THAT I POSSESS THE PHYSICAL STANDARDS PRESCRIBED FOR THE POST(S) WHICH I AM NOW APPLYING.
• I CERTIFY THAT I HAVE NOT BEEN DEBARRED / DISQUALIFIED BY THE MADRAS HIGH COURT OR ANY OTHER RECRUITING AGENCY.
• I AM NOT A DISMISSED GOVERNMENT EMPLOYEE.
• I HAVE VERIFIED THE CORRECTNESS OF THE PARTICULARS FURNISHED IN THE APPLICATION AND TAKEN A PRINT OUT OF THE
APPLICATION.
• I AM FULLY AWARE THAT NO INDIVIDUAL COMMUNICATION REGARDING THE DATE AND TIME OF EXAMINATION, ORAL TEST, CERTIFICATE
VERIFICATION AND COUNSELLING (WHEREVER APPLICABLE) WILL BE SENT TO ME. I AM ALSO AWARE THAT THE SCHEDULE OF ORAL TEST/
COUNSELLING/CERTIFICATE VERIFICATION WILL BE MADE AVAILABLE ON THE MADRAS HIGH COURT'S WEBSITE AND I HAVE TO KNOW THE
ABOVE DETAILS ON RECEIPT OF EMAIL/PRESS RELEASE/SMS ALERTS FROM THE COMMISSION TO THIS EFFECT.
• I HAVE NOT SUPPRESSED (OR) WITHHELD ANY INFORMATION RELEVANT FOR THIS RECRUITMENT.
• I KNOW THAT IN THE EVENT OF SELECTED I AM NOT ELIGIBLE FOR TRANSFER TO THE OTHER DISTRICTS.
• I HEREBY DECLARE THAT THE DETAILS FURNISHED ABOVE ARE CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I
HAVE NOT SUPPRESSED ANY INFORMATION, THAT I POSSESS SOUND HEALTH AND ACTIVE HABIT, THAT I AM FREE FROM ANY BODILY
DEFECT OR INFIRMITY WHICH WOULD RENDER ME UNFIT TO WORK IN SUBORDINATE SERVICE, THAT I AM NOT AWARE OF ANY OTHER
CIRCUMSTANCES WHICH MAY IMPAIR MY FITNESS FOR EMPLOYMENT UNDER THE GOVERNMENT, THAT MY CHARACTER AND ANTECEDENTS
ARE SUCH THAT THEY WILL NOT DISQUALIFY ME FROM SERVICE, THAT I HAVE READ AND UNDERSTOOD THE TERMS AND CONDITIONS
STIPULATED IN THE NOTIFICATION IN RESPONSE TO WHICH THE APPLICATION HAS BEEN SUBMITTED AND THAT I SHALL ABIDE BY THE
RELEVANT RULES AND OTHER CONDITIONS OF RECRUITMENT LAID DOWN FROM TIME TO TIME.

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SUBMITTED DATE : 20-APR-2021 (SIGNATURE OF THE CANDIDATE)