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9 views

Applicationform Draft Print For All

Uploaded by

jeryagowbksbowbzkvsk
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), NIA, SSF AND RIFLEMAN (GD) IN
ASSAM RIFLES EXAMINATION, 2021

REGISTRATION NO: 72001698392

APPLICATION IS PROVISIONALLY ACCEPTED

1. NAME AS PER MATRICULATION 2. NEW/CHANGED


3. FATHER'S NAME 4. MOTHER'S NAME
CERTIFICATE NAME
VINOD KUMAR MEENA - KAMLESH KUMAR MEENA SUNITA DEVI
6. AGE AS ON
5. DATE OF BIRTH (DD/MM/YYYY) 7. GENDER 8. CATEGORY
01/08/2021
10/02/1996 25.5 MALE ST
9. NATIONALITY 10. MARK OF VISIBLE IDENTIFICATION
CITIZEN OF INDIA CUT MARK RIGHT FINGER
12. MATRICULATION (10th 13. MATRICULATION (10th
11. MATRICULATION (10th CLASS) EXAMINATION BOARD
CLASS) ROLL NO CLASS) YEAR OF PASSING
BOARD OF SECONDARY EDUCATION, RAJASTHAN 0081540 2009
14.1. WHETHER YOU ARE AN EX-SERVICEMAN (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 ARMED FORCES
(DD/MM/YYYY)
- -
14.5. HAVE YOU ALREADY JOINED A CIVIL POST BY
AVAILING BENEFIT OF RESERVATION FOR EX- 14.6. DATE OF JOINING TO CIVIL POST (DD/MM/YYYY)
SERVICEMAN (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)
16.2. TYPE OF THE NCC CERTIFICATE
CERTIFICATE HOLDER
NO -
17. PREFERENCE OF EXAMINATION CENTERS

EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER


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

ALWAR ( 2402 ) JAIPUR ( 2405 ) BHARATPUR ( 2403 )

18. STATE/ UT OF DOMICILE 19. DISTRICT OF DOMICILE

RAJASTHAN ALWAR
20.1. HAVE YOU MIGRATED FROM THE STATE/ UT 20.2. WHETHER YOU WOULD LIKE TO AVAIL THE BENEFIT OF
OF YOUR ORIGIN TO ANOTHER STATE/ UT RESERVATION FROM THE STATE/ UT OF YOUR ORIGIN
NO -
20.3. STATE/ UT OF ORIGIN 20.4. DISTRICT OF ORIGIN
- -
21. CANDIDATE BELONGS TO MILITANCY/ NAXAL
22. CANDIDATE BELONGS TO BORDER DISTRICT
AFFECTED DISTRICT
NO NO
23. PREFERENCE OF POST FOR CAPF(S)/ ORGANIZATION(S)
B,D,A,H,F,E
24. HIGHEST EDUCATIONAL QUALIFICATION
MATRICULATION/ 10TH CLASS PASS (1)
25. DETAILS OF QUALIFYING EDUCATION
10TH STANDARD
STATUS PASSING STATE/ UT OF BOARD/ NAME OF BOARD/ ROLL NO PERCENTAGE CGPA
YEAR UNIVERSITY UNIVERSITY
PASSED 2009 RAJASTHAN BOARD OF 0081540 43.83 -
SECONDARY
EDUCATION,
RAJASTHAN
26. 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
27. CORRESPONDENCE ADDRESS 28. PERMANENT ADDRESS
123, DABLA KHOH DARIBA, TEH- RAJGARH 123, DABLA KHOH DARIBA, TEH- RAJGARH
DISTRICT: ALWAR DISTRICT: ALWAR
STATE: RAJASTHAN STATE: RAJASTHAN
PIN: 301410 PIN: 301410
MOBILE NO. : 7240167185 EMAIL ID: [email protected]
29. DATE ON WHICH PHOTOGRAPH HAS BEEN TAKEN 30. WHETHER THE DATE OF PHOTOGRAPH IS CLEARLY
(DD/MM/YYYY): PRINTED ON THE PHOTOGRAPH

07/08/2021 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.
PRINT TAKEN ON: 08/08/2021 9:12:19 PM IP ADDRESS: 157.47.255.230

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