Personal Information

Post Name Co-operative Supervisor & Environment Supervisor

Have you applied against advertisement number:

34/UKSSSC/2021 Dated 30-06-2021 (Co-operative No
Supervisor & Environment Supervisor) published by
UKSSSC
Application Number ECL208821

Application Status Completed

Candidate's Name GAURAV SINGH BHATIYA

Father's Name/Husband's Name LAXMAN SINGH BHATIYA

Mother's Name ANITA DEVI

Date of Birth 20/03/2004

Age (As on 01 Jul, 2023) 19 years 3 months 12 days

Gender Male

Marital Status Unmarried

Email Id [email protected]

Mobile No. 63XXXXX271

Place of filling form Jasari

Domicile of Uttarakhand? Yes

Nationality Indian

Required Eligibility
1.Is your name registered in any District Employment Office located in Uttarakhand State? No

2.Are You Employed? No

Have you passed your High School and Intermediate or any other equivalent exam from any recognized
3. Yes
institution situated in the State of Uttarakhand
Are you or your spouse or your parents regular employees of the Armed Forces/Paramilitary Forces
4(i).serving in the state of Uttarakhand and whose services cannot be transferred outside the state of No
Uttarakhand?
Are you or your spouse or your parents regular employees of the State Government/Semi Government
4(ii).organisation serving on a regular basis in the state of Uttarakhand and whose services cannot be No
transferred outside the state of Uttarakhand?
Are you or your spouse or your parents regular employees of Central Government organisation/ Central
4(iii).Government Public Service Undertaking and are working regularly in the State of Uttarakhand and whose No
services cannot be transferred outside the State of Uttarakhand?
Are you permanent resident of Uttarakhand but residing outside Uttarakhand for livelihood/education
5(i). No
purposes?
Is your spouse or your parents permanent residents of Uttarakhand but are residing outside Uttarakhand
5(ii). No
for livelihood/education purposes?

Category / Sub Category Reservation Details

Category Unreserved/General

Sub Category Details

Differently abled(PH) No

Ex-Servicemen No

Dependent of Freedom Fighter (DFF) No

Are you a permanent resident of the State of Uttarakhand covered by

Government Order No. 179/XXX(2)/2021-30(2)/2019, dated 31st
August 2021, for such affected children (whose biological/adoptive
parents both died after the birth of the child)? within a period of up to No
21 years) OR Orphan Child residing in government/voluntary homes
functional and registered under the Department of Women
Empowerment and Child Development in the state of Uttarakhand
Claimed Category/Sub Category Unreserved/General

Address Details

Present Address
Line1 Jasari, Ratanpur
Line2 Ratanpur
City / Town / Village Jhunkat
District Udham Singh Nagar
State Uttarakhand
Pincode 262308

Permanent Address
Line1 Jasari, Ratanpur
Line2 Ratanpur
City / Town / Village Jhunkat
District Udham Singh Nagar
State Uttarakhand
Pincode 262308

Educational Qualifications Details

Date of Percentage
Marks Maximum
Name of University / University / Issuing Final Subject / Grade of Marks
Qualification Type Marks Type Obtained / Marks /
Degree Board State Board Year Stream Obtained Obtained /
CGPA / CPI CGPA / CPI
Marksheet Equivalent
Uttrakhand
High Board of High School
High School(10th) School(10th) Uttarakhand School 2020 Subjects MARKS 364.00 500.00 - 72.80
Education
Chemistry,
Uttrakhand
English,
Intermediate Board of
Intermediate(12th) Uttarakhand 2022 Hindi, MARKS 290.00 500.00 - 58.00
(Science) School
Physics,
Education
Mathematics

Preferential Qualification
Have you Served in the Territorial army for a minimum period of two years? No

Do You Possesses "B" Certificate of National Cadet Corps? No

Other Details
Group 2 (Physics, Chemistry,
Subject for Objective Exam Part-B
Mathematics)

Exam Centre Preference 1 Udham Singh Nagar

Exam Centre Preference 2 Dehradun

Is there any criminal case pending against you? No

Whether debarred or Black Listed for Examination/ Selection held by UKPSC / UPSC / Other State
No
Public Service Commission?
 Candidate ID Proof Aadhaar Card

ID Proof Number 75XXXXXXXX66

Fee Details
Application Fee Fee Exempted

Declaration

1. I GAURAV SINGH BHATIYA hereby declare that I have carefully read all the eligibility conditions mentioned in the advertisement and the
above mentioned information in this application form. I accept and complete those requirements.
एतद्द्वारा घोषणा करता हूं कि मैंने विज्ञापन में उल्लिखित पात्रता की सभी शर्तों और इस आवेदन पत्र में दी गई उपरोक्त जानकारी को सावधानीपूर्वक पढ़ लिया है। मैं उन
आवश्यकताओं को स्वीकार करता हूं और उन्हें पूरा करता हूं।
2. I also declare that all the details / information given in this application form is true and correct and I have not hidden any facts in these
particulars / information. If any details / information is found to be false or incorrect or if any facts are hidden by me, then my candidature
should be cancelled. If such situation comes to light after the appointment, then my services should be terminated.
यह भी घोषणा करता हूं कि इस आवेदन पत्र में दिए गए सभी विवरण/सूचनाएं सत्य और सही हैं और मैंने इन विवरणों/जानकारी में कोई तथ्य नहीं छिपाया है। यदि मेरे द्वारा कोई
विवरण/सूचना असत्य या असत्य पायी जाती है या कोई तथ्य छु पाया जाता है तो मेरी उम्मीदवारी रद्द कर दी जाये। अगर नियुक्ति के बाद ऐसी स्थिति सामने आती है तो मेरी सेवाएं
समाप्त कर दी जानी चाहिए।

Place of filling form: Jasari

Submitted Date & Time : 15/07/2023 07:51:31
Print Date : 15/07/2023

Signature of Candidate