h t t p s : / / o n e l i m e r e g n . h a r y a n a . g o v . i n / P r i n t A p p .

a s p x

6/3/22, 8:25 AM

Registration 1D :
Haryana Staff Selection 1480953
Commission

VINEET KUMAR YADAV

1. Applicant's Name:
MAHENDRA SINGH YADAV
2. Father's Name:
MUKESH DEVI
3. Mother's Name:
MALE
4. Gender:
02/12/1990
5. Date of Birth:
Madoy
MARRIED
6. Marital Status:

INDIAN
7. Nationality:
THUMB IS SMALL
RIGHT HAND
Mark on body:
8. Visible Indentity
9. If any FIR is lodged/Pending
NO

against the applicant?:

STREET NO- H
HOUSE NO.- 26/
Details:
10. Address & Contact MARK- HOUSE
BLOCK NIT3/ LAND
FARIDABAD
NO 26 H BLOCK
NIT 3
PINCODE- 121001,
HARYANA 121001/
WARD 10, FARIDABAD MC,
FARIDABAD, HARYANA, 121001

8955444824
11. Mobile No
[email protected]

12. Email ld:

Reservation DetailsS
BC (B)
13. Category:
NO
14. Benchmark Disability
NO
15. EWS:
NO
16. Ex-Serviceman: GROUP C
:
17. Interested Job Category
NO
18. Eligible Sports Person (ESP):
YES
of Haryana State:
19. Are you domicile
YES
Dependent)7:
20. Is DESM (Ex-Servicemen
Hindi/Sanskrit in class 10th or YES
21. Did you passed/studying
above?:
FEE NOT PAID YET
22. Payment Detail:
of YES
the benefit of reservation policy
23. Would you be availing D
in recruitment to Group C and Group
Goverment of Haryana

posts?:
Qualifying Examination Details

Roll No. Marksheet No Grading Mark Total Percentage

Education Board Result System Obtained Marks
University Type

Class10th
Rajasthan Pass 0325785 0328868 Non
CGPA
427 600 7117
Board o

Secondary
EducauOn

1140227 083471 O n 332 650 51 08

Class12th Rajasthan Pass CGPA
Board of
Secondary
Education

Graduation Shridhar Pass J10BSMATO0014470 31895316 CGPA NIA N/A 6162

University
Pilani
Chirawa
Road,
Pilani

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Rajasthan
333031.
(Private
University)
Pass 2132128713903 TPR31287SC001071 Non 564 G00 647
Post Sunrise CGPA
Graduatron Oniversily
Bagad
Rajput
Tech
Ramgarti
ANVar
Rajasthan
(Private
Universily)

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Socio Economic Criteria
1. Any person from among the applicant's father, mother, NO
has been a regular
spouse, brother and son is/ was or
in department/ Board/ Corporation/ Company
employee any
of Government of
Statutory Body/ Commission/ Authority
Government or Government of
Haryana or any other state
India:
NO
2. Is Applicant a Widow?
YES
3. Is father of candidate is deceased?:
denotified tribe(Vimukt NO
4. If the applicant belongs to such a

Jatis and Tapriwas Jatis) or Nomadic tribe of Haryana which Is

Backward Class.
nether a Scheduled Caste nor
a

NO
5. Age relaxation due to experience:

Experience Details

Declaration by Candidate will be

this rule. My application
for this recruitment. I know if I violate
1.Thave not sent any other application
cancelled by the Staff Selection Commission,

and
conditions given in the release and hereby I am eligible for thiS post
2.Uhave carefully read all the
abide by them I promise to.

and finds which

related age limits, educational qualifications
3.1also declare that I fulfils all the condition
are prescribed for this recruitment.

Ex-Serviceman related eligibility as per

4. For Ex-Servicemen, I announce that
fulfils all the conditions of

advertisement.
from appearing in any examination / experiential
5.1also declare that till date I have not been prevented
convicted by any
selection committee of the State of Haryana and have not been
course by any agency/
legal court

declare that I belong to the community

the Other Backward Classes, I
6. For the candidates belonging to State
class for the purpose of reservation in services by the
backward
which has been considered as a State Government, by the
announced that the
Government orders. It is also
Government, as per the State individuals / categories.lalso
in the notice are not related to the mentioned
various amendments mentioned
declare that I have a certificate
of OBC.

the Government of
7.Ialso declare that I have applied only in one reserved category prescribed by
Haryana.
in this application form are true, complete and correct as per my
3. 1 hereby declare that all
the details given
understand that my candidature/appointment can be
belief. I understand /
maximum information and
hidden/ false or untrue or if ineligibility is detected.
cancelled if any is found to be
information

Place: GURGAON

Date:03/06/2022
Candidate Signature

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