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High Court of Bombay Application Form For The Post of PEON/HAMAL

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Satish Kacharu Dandge
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37 views4 pages

High Court of Bombay Application Form For The Post of PEON/HAMAL

Uploaded by

Satish Kacharu Dandge
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
You are on page 1/ 4

HIGH COURT OF BOMBAY

Application Form for The Post of PEON/HAMAL

Registration-ID :- PEN3204

Name of the Applicant :- Shri. RAHUL KACHARU DANDGE

Address for correspondence :- ROOM NO 195 AANAND


NAGAR PATRA CHAWL
MHADA COLONY
ZOPADPATTI MUMBAI
MULUND EAST
District of Postal Address :- MUMBAI - 400081

Mobile No. :- 8788494941

Email :- [email protected]

Nationality :- Indian

Gender :- Male

Religion, Category/Caste :- Hindu, Schedule Castes (CHAMBAR)

Date of Birth :- 16/01/1997

Place of Birth :- MUMBAI

Age as on 24/03/2023 :- 26 Years 2 Months 8 Days

Marital Status :- Single

Whether Candidate is :- No
Differently-abled Person?

Educational Qualification :-

Course/Degree Board/University Year of Marks Out of Class Percent


Passing Obtained Marks %
Below S.S.C. (7th RR 2010 325 650 IInd 50.00
STD.) EDUCATIONAL
TRUST
S.S.C. (S.S.C.) MUMBAI 2014 256 650 PASS 39.38
BOARD
H.S.C. AURANGABAD 2019 390 650 Ist 60.00
(Commerce) BOARD

Is the Candidate Domicile :- Yes


of Maharashtra

Language Known :-
Marathi Hindi English
Yes Yes Yes
Page 1/4
Does candidate work in any :- No
Government Department ?

Whether candidate has :- No


enrolled his/her name at
Employment Exchange?

(a) Is there any criminal :- No


proceeding pending against
the candidate?

(b) Is he/she convicted by a :- No


Criminal Court?

(c) Is he/she facing :- No


disciplinary/deparment
enquiry?

Whether permanently :- No
debarred or disqualified by
any Court/MPSC/UPSC or
any State Service
Commission from
appearing in any
examination conducted by
them?

Name and address of two :- 1) SANDEEP MUKANE


respectable persons who DOCTOR
know the candidate. 8433784701
KDMC Hospital Dombivli KDMC Hospital Kopar Gaon
Road Shastri Nagar Dombivli West Dist Thane 421202

2) KAILASH BHGWANDAS CHAVAN


SAFAI KAMGAR
8369784073
HARIJAN COLONY PENDSE NAGAR HIPPY ROAD
DOMBIVLI EAST

Fee Details :- Payment Gateway:- SBI Collect


Payment Type :- ePayment
SBCollect Ref. No.
:- DUK7058103
Date :- 25/03/2023
Amount :- Rs. 25

Page 2/4
Signature of Applicant

FOR OFFICE USE

Affix your
passport size
photo here

Signature of Applicant

Printed on 25/03/2023 13:27:48

Page 3/4
DECLARATION

1) I the applicant Shri. RAHUL KACHARU DANDGE


do hereby declare that I have not been arrested or convicted or held guilty or facing disciplinary enquiry for any offence
and that no case is pending against me in any Criminal Court for any offence.

2) I also affirm that all the details filled up in the application are true and correct as per my knowledge. If any
information is found to be false/incorrect, I will be liable to be disqualified from the process of selection and if
selected/appointed, my services would be liable to be terminated without any notice.

3) I have -NA- (Number) living children as on today. Out of which No. -NA- of children born after 28th March, 2005 is
-NA- (mentioned dates of birth, if any).

4) I am aware that, if any total number of living children are more than two due to the children born after 28th March
2006, I am liable to be disqualified for the same post.

Place: MUMBAI

Date: 25/03/2023

RAHUL KACHARU DANDGE

Name and Signature of Applicant

Page 4/4

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