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Applicationform Draft Print for All

The document is an incomplete application for the Junior Engineer Examination 2023, submitted by AAFAQ AHMAD BHAT. Key details include personal information, educational qualifications, and preferences for examination centers. The applicant has acknowledged the terms and conditions of the examination and provided a declaration regarding the accuracy of the information submitted.

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Imran Malik
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9 views3 pages

Applicationform Draft Print for All

The document is an incomplete application for the Junior Engineer Examination 2023, submitted by AAFAQ AHMAD BHAT. Key details include personal information, educational qualifications, and preferences for examination centers. The applicant has acknowledged the terms and conditions of the examination and provided a declaration regarding the accuracy of the information submitted.

Uploaded by

Imran Malik
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
JUNIOR ENGINEER (CIVIL, MECHANICAL,
ELECTRICAL AND QUANTITY SURVEYING &
CONTRACTS) EXAMINATION, 2023
REGISTRATION NO: 40006815468

APPLICATION IS INCOMPLETE

1. NAME AS PER MATRICULATION 2. NEW/ CHANGED


3. FATHER'S NAME 4. MOTHER'S NAME
CERTIFICATE NAME
AAFAQ AHMAD BHAT - GH RASOOL BHAT HAMEEDA
6. AGE AS ON
5. DATE OF BIRTH (DD/MM/YYYY) 7. GENDER 8. CATEGORY
01/08/2023
06/12/2000 22.7 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 NECK BACKSIDE
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
6135253 2015
EDUCATION
15. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER
(FIRST PREFERENCE) (SECOND PREFERENCE) (THIRD PREFERENCE)
SRINAGAR (J&K) ( 1007 ) CHANDIGARH ( 1601 ) JAMMU ( 1004 )
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
PUNJAB
PASSED 2022 PUNJAB TECHNICAL 1816376 - 7.68
UNIVERSITY
20.1 HIGHEST EDUCATIONAL QUALIFICATION
B.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
169 SHAH COLONY KHREW KHREW PULWAMA KASHMIR 169 SHAH COLONY KHREW KHREW PULWAMA KASHMIR
DISTRICT: PULWAMA DISTRICT:PULWAMA
STATE: JAMMU AND KASHMIR STATE: JAMMU AND KASHMIR
PIN : 191103 PIN : 191103
MOBILE NO: 6005060084 EMAIL: [email protected]
24. CONTACT FOR OTHER NATIONALS

25. WHETHER THE PHOTOGRAPH HAS BEEN TAKEN ON OR AFTER 27-APR-2023?


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: 16/08/2023 10:12:09 PM IP ADDRESS:137.59.1.150


NUMBER OF ATTEMPT: 1

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