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Bharathi Nadimpalli
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10 views

Applicationform Draft Print For All

Uploaded by

Bharathi Nadimpalli
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
CONSTABLES (GD) IN CENTRAL ARMED POLICE FORCES
(CAPFs), SSF AND RIFLEMAN (GD) IN ASSAM RIFLES
EXAMINATION 2024

REGISTRATION NO: 71000762179

APPLICATION RECEIVED (CONTENTS NOT VERIFIED)

1. NAME AS PER MATRICULATION 2. NEW/CHANGED


3. FATHER'S NAME 4. MOTHER'S NAME
CERTIFICATE NAME
JANNI MOHANARAO - JANNI DANDASI JANNI POLAMMA
5. DATE OF BIRTH (DD/MM/YYYY) 6. AGE AS ON 01/01/2024 7. GENDER 8. CATEGORY
25/04/1998 25.8 MALE ST
9. NATIONALITY 10. MARK OF VISIBLE IDENTIFICATION
CITIZEN OF INDIA A MOLE ON THE CHEST
12. MATRICULATION (10th CLASS) 13. MATRICULATION (10th
11. MATRICULATION (10th CLASS) EXAMINATION BOARD
ROLL NO CLASS) YEAR OF PASSING
BOARD OF SECONDARY EDUCATION ANDHRA PRADESH 1405140286 2014
14.1. WHETHER YOU ARE AN EX-SERVICEMEN (ESM) OR
14.2. DATE OF JOINING THE ARMED FORCES (DD/MM/YYYY)
SERVING IN THE ARMED FORCES?
NO -
14.3. DATE OF DISCHARGE FROM ARMED FORCES
14.4. LENGTH OF SERVICE IN THE ARMED FORCES
(DD/MM/YYYY)
- -
14.5. HAVE YOU ALREADY JOINED A CIVIL POST BY AVAILING
14.6. DATE OF JOINING TO CIVIL POST (DD/MM/YYYY)
BENEFIT OF RESERVATION FOR EX-SERVICEMEN (ESM) ?
- -
15.1. WHETHER SEEKING AGE RELAXATION? 15.2 IF YES, AGE RELAXATION CODE
YES 01-SC/ST
16.1. ARE YOU A NATIONAL CADET CORPS (NCC) CERTIFICATE
16.2. TYPE OF THE NCC CERTIFICATE
HOLDER
NO -
17. PREFERENCE OF EXAMINATION CENTRES

EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER


( FIRST PREFERENCE ) ( SECOND PREFERENCE) ( THIRD PREFERENCE)

VISHAKHAPATNAM ( 8007 ) VIZIANAGARAM ( 8012 ) RAJAHMUNDRY ( 8004 )

18. MEDIUM FOR COMPUTER BASED 19. STATE/ UT OF DOMICILE 20. DISTRICT OF DOMICILE
EXAMINATION (CBE)
TELUGU ANDHRA PRADESH SRIKAKULAM
21.1. HAVE YOU MIGRATED FROM THE STATE/ UT OF 21.2. WHETHER YOU WOULD LIKE TO AVAIL THE BENEFIT OF
YOUR ORIGIN TO ANOTHER STATE/ UT RESERVATION FROM THE STATE/ UT OF YOUR ORIGIN
NO -
21.3. STATE/ UT OF ORIGIN 21.4. DISTRICT OF ORIGIN
- -
22. CANDIDATE BELONGS TO MILITANCY/ NAXAL
23. CANDIDATE BELONGS TO BORDER DISTRICT
AFFECTED DISTRICT
YES NO
24. PREFERENCE OF POST FOR CAPF(S)/ ORGANIZATION(S)
B,A,C,E,F,D,H,
25. HIGHEST EDUCATIONAL QUALIFICATION
B. ED. (11)
26. DETAILS OF QUALIFYING EDUCATION
10TH STANDARD
STATUS PASSING STATE/ UT OF BOARD/ NAME OF BOARD/ ROLL NO PERCENTAGE CGPA
YEAR UNIVERSITY UNIVERSITY
PASSED 2014 ANDHRA PRADESH BOARD OF 1405140286 - 8.8
SECONDARY
EDUCATION ANDHRA
PRADESH
27. 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
28. CORRESPONDENCE ADDRESS 29. PERMANENT ADDRESS
DABARU VILLAGE SIRIAKHANDI POST MELIAPUTTI MANDAL DABARU VILLAGE SIRIAKHANDI POST MELIAPUTTI MANDAL
DISTRICT: SRIKAKULAM DISTRICT: SRIKAKULAM
STATE: ANDHRA PRADESH STATE: ANDHRA PRADESH
PIN: 532215 PIN: 532215
MOBILE NO. : 9573312063 EMAIL ID: [email protected]
30. WHETHER PHOTOGRAPH HAS BEEN TAKEN ON OR AFTER 24-AUGUST-2023?
YES
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE

EXEMPTED - - -
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 AADHAR DATA FOR VERIFICATION PURPOSE.


PRINT TAKEN ON: 28/09/2024 8:16:32 PM IP ADDRESS: 106.221.188.87

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