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Staff Selection Commission: Combined Higher Secondary (10+2) Level Examination 2018

This document is an application for the Combined Higher Secondary (10+2) Level Examination 2018 from Churamani. It contains details such as his name, father's name, date of birth, category, education qualifications, address and contact information. Churamani has applied for the examination under the OBC category and seeks to take the exam in Raipur as his first preference center. He has completed his 10th and 12th education from Chhattisgarh boards and obtained a B.Sc. degree.

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Salman Raza
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17 views2 pages

Staff Selection Commission: Combined Higher Secondary (10+2) Level Examination 2018

This document is an application for the Combined Higher Secondary (10+2) Level Examination 2018 from Churamani. It contains details such as his name, father's name, date of birth, category, education qualifications, address and contact information. Churamani has applied for the examination under the OBC category and seeks to take the exam in Raipur as his first preference center. He has completed his 10th and 12th education from Chhattisgarh boards and obtained a B.Sc. degree.

Uploaded by

Salman Raza
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

COMBINED HIGHER SECONDARY (10+2) LEVEL


EXAMINATION 2018

REGISTRATION NO: 95000206910

APPLICATION IS PROVISIONALLY ACCEPTED


1. NAME AS PER
2. NEW/CHANGED
MATRICULATION 3. FATHER'S NAME 4. MOTHER'S NAME
NAME
CERTIFICATE
CHURAMANI - JIVARAKHAN GURUGOSAI PANCH BAI
5. DATE OF BIRTH (DD/MM/YYYY) 6. AGE AS ON 01/08/2019 7. GENDER
25/06/1997 22.1 MALE
9.1 .IF YES, TYPE OF
9. WHETHER PERSON WITH
8. CATEGORY DISABILITY (OH, HH,VH,
DISABILITY (PWD) ?
OTHERS)
OBC NO -
10. NATIONALITY 11. MARK OF VISIBLE IDENTIFICATION
CITIZEN OF INDIA MOLE ON THE FACE
12. MATRICULATION (10th CLASS) EXAMINATION 13. MATRICULATION (10th 14. MATRICULATION (10th
BOARD CLASS) ROLL NO CLASS) YEAR OF PASSING
CHHATTISGARH BOARD OF SECONDARY
1133229485 2013
EDUCATION
15. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER ( FIRST ) EXAMINATION CENTER ( SECOND ) EXAMINATION CENTER ( THIRD )
RAIPUR (6204) BHILAI NAGAR (6206) BILASPUR (6202)
17. WHETHER 12th STANDARD PASS IN SCIENCE STREAM WITH
16. MEDIUM OF TYPE TEST MATHEMATICS AS A SUBJECT FROM A RECOGNIZED BOARD OR
EQUIVALENT (FOR C&AG AS DATA ENTRY OPERATOR)
HINDI NO
18.1. HAVE YOU ALREADY
JOINED A CIVIL POST BY 18.3. DATE OF DISCHARGE
18.WHETHER EX- 18.2. LENGTH OF SERVICE IN
AVAILING BENEFIT OF FROM ARMED FORCES
SERVICEMAN (ESM)? ARMED FORCES ( IN YEARS )
RESERVATION FOR EX- (DD/MM/YYYY)
SERVICEMAN (ESM) :?
NO - - -
19.1 DO YOU SUFFER FROM CEREBRAL-PALSY:
-
19.2 DO YOU HAVE A PHYSICAL LIMITATION TO WRITE AND SCRIBE IS REQUIRED TO WRITE ON YOUR BEHALF
(CERTIFICATE TO THIS EFFECT FROM THE CHIEF MEDICAL OFFICER/ CIVIL SURGEON & MEDICAL
SUPERINTENDENT OF A GOVERNMENT HEALTH CARE INSTITUTION AS PER NOTICE OF THE EXAMINATION
WOULD BE REQUIRED AT THE TIME OF EXAMINATION)?
NO
19.5 IF SCRIBE IS TO BE
19.4 WILL YOU MAKE YOUR OWN
19.3 WHETHER SCRIBE IS REQUIRED ARRANGED BY SSC, INDICATE
ARRANGEMENT OF SCRIBE?
MEDIUM
NO - -
20. WHETHER SEEKING AGE RELAXATION? 20.1 IF YES,INDICATE CODE
NO -
21. EDUCATIONAL QUALIFICATION
B.SC.

22. DO YOU BELONG TO ECONOMICALLY WEAKER SECTIONS (EWS) ?

-
23. 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 ?
NO

ADDRESS DETAIL
24. POSTAL ADDRESS 25. PERMANENT ADDRESS
VILLAGE-PAKARIYA DIST-JANJGIR CHAMPA CG VILLAGE-PAKARIYA DIST-JANJGIR CHAMPA CG
DISTRICT: RAIPUR DISTRICT: RAIPUR
STATE: CHHATTISGARH STATE: CHHATTISGARH
PIN: 495554 PIN: 495554
MOBILE NO : 7587302293 EMAIL ID : [email protected]
SIGNATURE

FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE


NOT EXEMPTED 100 CPO5058730 13/03/2019
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: 13/03/2019 8:20:06 PM

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