Scribd
Upload
9 views

Application Form Draft Print For All

This document is an application form for the Junior Engineer (Civil, Mechanical, Electrical and Quantity Surveying & Contracts) Examination, 2023 by the Staff Selection Commission. It contains the applicant's personal details such as name, father's name, date of birth, gender, nationality, address, qualification details, preference of examination centers, declaration, and other required information. However, the application is marked as incomplete, likely due to missing required documents or payment of fees.

Uploaded by

Mir shakir Zahoor
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
9 views

Application Form Draft Print For All

This document is an application form for the Junior Engineer (Civil, Mechanical, Electrical and Quantity Surveying & Contracts) Examination, 2023 by the Staff Selection Commission. It contains the applicant's personal details such as name, father's name, date of birth, gender, nationality, address, qualification details, preference of examination centers, declaration, and other required information. However, the application is marked as incomplete, likely due to missing required documents or payment of fees.

Uploaded by

Mir shakir Zahoor
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/ 3

STAFF SELECTION COMMISSION

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


110003
JUNIOR ENGINEER (CIVIL, MECHANICAL,
ELECTRICAL AND QUANTITY SURVEYING &
CONTRACTS) EXAMINATION, 2023
REGISTRATION NO: 40000758452

APPLICATION IS INCOMPLETE

1. NAME AS PER MATRICULATION 2. NEW/ CHANGED


3. FATHER'S NAME 4. MOTHER'S NAME
CERTIFICATE NAME
SHAKIR ZAHOOR MIR - ZAHOOR AHMAD MIR ZAMROODA
6. AGE AS ON
5. DATE OF BIRTH (DD/MM/YYYY) 7. GENDER 8. CATEGORY
01/01/2022
05/03/1998 25.4 MALE 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 MOLE ON FACE
13. MATRICULATION (10th 14. MATRICULATION (10th
12. MATRICULATION (10th CLASS) EXAMINATION BOARD
CLASS) ROLL NO CLASS) YEAR OF PASSING
JAMMU AND KASHMIR STATE BOARD OF SCHOOL
611224 2012
EDUCATION
15. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER
(FIRST PREFERENCE) (SECOND PREFERENCE) (THIRD PREFERENCE)
SRINAGAR (J&K) ( 1007 ) JAMMU ( 1004 ) CHANDIGARH ( 1601 )
16.1. WHETHER YOU ARE AN EX- 16.2. DATE OF JOINING THE ARMED 16.3. DATE OF DISCHARGE/ LIKELY DATE OF
SERVICEMAN (ESM) OR SERVING FORCES (DD/MM/YYYY) DISCHARGE FROM ARMED FORCES (DD/MM/
IN THE ARMED FORCES? YYYY)
NO - -
16.5. HAVE YOU ALREADY JOINED A
16.4. LENGTH OF SERVICE IN THE CIVIL POST BY AVAILING BENEFIT 16.6. DATE OF JOINING TO CIVIL POST
ARMED FORCES OF RESERVATION FOR EX- (DD/MM/YYYY)
SERVICEMAN (ESM) ?
- - -
17. WHETHER SUFFERING FROM CEREBRAL PALSY ?
-
17. 1 ARE YOU A PERSON WITH BENCHMARK DISABILITIES (40% OR MORE) IN THE CATEGORY OF BLINDNESS (VH)?

17.2 ARE YOU A PERSON WITH BENCHMARK DISABILITIES (40% OR MORE) IN THE CATEGORY OF OHBOTH ARMS AFFECTED
(OH-BA) OR OI-I- CEREBRAL PALSY (OH-CP)?

17.3 DO YOU HAVE A PHYSICAL LIMITATION TO WRITE AS PER PARA 9.2 OR 9.3 OF THE NOTICE (CERTIFICATE TO THIS EFFECT
FROM COMPETENT AUTHORITY AS PER FORMAT AT ANNEXURE-I/ ANNEXURE-IA TO THE NOTICE OF EXAMINATION, WOULD
BE REQUIRED AT THE TIME OF EXAMINATION.)?
17.4 WHETHER SCRIBE IS REQUIRED ? 17.5 WILL YOU MAKE YOUR OWN 17.6 IF SCRIBE IS TO BE ARRANGED BY
ARRANGEMENT OF SCRIBE ? SSC, INDICATE MEDIUM
- - -

18.1. WHETHER SEEKING AGE RELAXATION ? 18.2. IF YES, AGE RELAXATION CODE
NO -
19. POST(S) APPLYING FOR
JE- CIVIL ENGINEERING
20. QUALIFICATION DETAILS
EXP(MIN. 2
QUALIFYING DIPLOMA/ DEGREE SUBJECT/ STREAM
YEARS)
DEGREE (52) CIVIL ENGINEERING 0
STATE/ UT OF
PASSING NAME OF BOARD/ PERCENTA
STATUS BOARD/ ROLL NO CGPA
YEAR UNIVERSITY GE
UNIVERSITY
THE I.K. GUJARAL
PUNJAB
TECHNICAL
UNIVERSITY
PASSED 2022 PUNJAB 2005165 - 7.7
(FORMERLY
PUNJAB
TECHNICAL
UNIVERSITY)
20.1 HIGHEST EDUCATIONAL QUALIFICATION
M.TECH.
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 ?
YES
ADDRESS DETAIL
22. CORRESPONDENCE ADDRESS 23. PERMANENT ADDRESS
NEAR ARMY CAMP NILLOW KULGAM NEAR ARMY CAMP NILLOW KULGAM
DISTRICT: KULGAM DISTRICT:KULGAM
STATE: JAMMU AND KASHMIR STATE: JAMMU AND KASHMIR
PIN : 192231 PIN : 192231
MOBILE NO: 7889411848 EMAIL: [email protected]
24. CONTACT FOR OTHER NATIONALS

25. WHETHER THE PHOTOGRAPH HAS BEEN TAKEN ON OR AFTER 12-MAY-2022?


YES
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.

3. I DECLARE THAT THE PHOTOGRAPH UPLOADED IN THE APPLICATION FORM HAS BEEN TAKEN ON OR
AFTER THE STIPULATED DATED.

4.I AGREE TO AUTHORIZE SSC TO USE MY AADHAAR DATA FOR VERIFICATION PURPOSE.

PRINT TAKEN ON: 03/08/2023 8:55:13 AM IP ADDRESS:169.149.195.142


NUMBER OF ATTEMPT: 1

You might also like