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UNION PUBLIC SERVICE COMMISSION

DETAILED APPLICATION FORM
ENGINEERING SERVICES (MAIN) EXAMINATION, 2019

Roll No. : 0405874

RID: 11902425064
Branch : MECHANICAL ENGINEERING

1. Name | VIVEK KUMAR MISHRA

2. (a) Address for correspondence to which | Q.NO.-2C6, GAJRA OFFICER COLONY,

communication is to be sent | BANKI MONGRA
Post Office: | KORBA
City: | KORBA
District: | KORBA
State : | CHATTISGARH
Pin Code : | 495447
(b) Telephone No. with STD Code | -
(c) Mobile No. | 7587450646
(d) Fax No. |
(e) E-mail address | [email protected]
(f) Permanent Postal Address | Q.NO.-2C6, GAJRA OFFICER COLONY
| GAJRA OFFICER COLONY
Post Office: | BANKI MONGRA
City: | KORBA
District: | KORBA
State : | CHATTISGARH
Pin Code : | 495447

3. Nationality | INDIAN

4. Gender | MALE

5. Marital Status | UNMARRIED

6. Citizenship | A CITIZEN OF INDIA(1)

7. State of Domicile | CHATTISGARH

8. (a) Date of Birth | 23-07-93

(b) Age Relaxation claimed | NO

Roll No. :- 0405874 | This is a Printout of "PREVIEW OF THE FORM".There is no need to send the Printout to the
commission.However, candidate may take a printout after final submission for future reference only.
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9. Place of Birth :
Town/Village | KORBA
District | KORBA
State | CHATTISGARH

10. (a) Community | GENERAL (4)

Note 1: Candidate belonging to OBCs but coming in the 'Creamy Layer' and thus not being entitled to OBC
reservation should indicate their community as 'General Category (others) Code No.4'.
Note 2: Candidates belonging to neither SC,ST nor OBC Communities should write 'General'
Category(Others) Code No.4' against the column of community and not leave it blank.'.
Note 3: No change in the community status already indicated by a candidate in his / her application form for this
examination will ordinarily be allowed by the Commission.
Note 4: In case you are a 'SC, ST or OBC' candidate, upload a scanned copy of certificate in support of your claim.
(f) Name of the Caste as mentioned in | ()
the Community Certificate and |
Name of the issuing State

11. What Languages(including Indian Languages) can you read/write or speak ? Give particulars and state the
examination(s) passed, if any, for each :-

Read Only Speak Only Read & Speak Read, Write & Examination(s)
Speak passed
ENGLISH BTECH FIRST YEAR
SANSKRIT 10 CLASS
HINDI 8TH CLASS

12. (a) Do you possess the prescribed Educational

Qualification (Vide rule-6 of the rules of the examination).
Please upload a scanned copy of the Certificate
if answer is "YES" | YES

(b) Do you have any Educational

Qualification obtained from a foreign
institution? | NO

13. Educational Qualifications : Commencing with Matriculation or equivalent examination till Graduation:-
Examination Class/ Percentage CGPA Year of Subject(s) Name of Name of
Passed Division of Score Out of School/College Board/University
/Grade Marks(%) Passing /Institution
10th or Equivalent First 91.6 2009 English, Sanskrit, D.A.V Public school, CBSE
Maths, Science, Kusmunda
Social Science
12th or Equivalent First 84.0 2011 English, Physical D.A.V Public school, CBSE
Education, Kusmunda
Mathematics
,Physics, Chemistry
Stream at Graduation Level :-- ENGINEERING
DEGREE IN First 7.9 10 2016 Mechanical MANIT- NIT MAULANA AZAD
ENGINEERING. BHOPAL NATIONAL
INSTITUTE OF
TECHNOLOGY,
BHOPAL, M.P.

Roll No. :- 0405874 | This is a Printout of "PREVIEW OF THE FORM".There is no need to send the Printout to the
commission.However, candidate may take a printout after final submission for future reference only.
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14. (a) Were you ever Employed : | YES

Details of your employment of any kind(in chronological order -till date):-
Designation/ Monthly Whether Period Name of Place of employment
Position remuneration Permanent/ From To employer/ (Address)
(Total) in Rs. Temporary/ Organisation/
Ad hoc etc. Firm/Individual
MANAGER 105300 PERMANENT 04-07-2016 28-06-2017 TRIDENT GROUP BUDHNI- HOSANGABAD
PRODUCTION

(b) Your present Employment :- | NOT EMPLOYED

15.(a) Name of Father | SUNIL KUMAR MISHRA

(b) Name of Mother | NUTAN MISHRA
(c) Nationality of Father | INDIAN
(d) Nationality of Mother | INDIAN
(e) Father's present postal Address | Q.NO.-2C6, GAJRA OFFICER COLONY, BANKI
MONGRA, KORBA
(If deceased give last address) | GAJRA OFFICER COLONY
Post Office: | BANKI MONGRA
City: | KORBA
District: | KORBA
State : | CHATTISGARH
Pin Code : | 495447
(f) Mother's present postal Address | Q.NO.-2C6, GAJRA OFFICER COLONY, BANKI
MONGRA, KORBA
(If deceased give last address) | GAJRA OFFICER COLONY
Post Office: | BANKI MONGRA
City: | KORBA
District: | KORBA
State : | CHATTISGARH
Pin Code : | 495447
(g) Father's Profession: | GOVT. SERVICE/PUBLIC SECTOR
(h) Mother's Profession: | HOUSEWIFE
(i) If your Father is in service,the post held
by him (if retired, indicate the post held
by him at the time of his retirement) | MANAGER MINING
(j) If your Mother is in service,the post held
by her (if retired, indicate the post held
by her at the time of her retirement) | NA
(k) Annual income of your Father | RS.2000000

Roll No. :- 0405874 | This is a Printout of "PREVIEW OF THE FORM".There is no need to send the Printout to the
commission.However, candidate may take a printout after final submission for future reference only.
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(l) Annual income of your Mother | RS.0
(m) State to which your Father originally | BIHAR
belongs
(n) District to which your Father originally | SAMASTIPUR
belongs
(o) State to which your Mother originally | BIHAR
belongs
(p) District to which your Mother originally| SAMASTIPUR
belongs
16. Have you claimed age relaxation
and/or fee exemption as Person
with Benchmark Disability candidates?
(If Yes,upload a scanned copy of
prescribed certificate in support of your claim).
of your claim). | NO

17. Your order of preference against the Services/Posts given below,for which ,you would like to be
considered for appointment. (Please write your first preference as 1 and second preference as 2 and so on ) .
In case no preference is exercised,then '0' shall be filled against each services(s).

Category : | MECHANICAL ENGINEERING

Name of Services/Post Order of Preference

INDIAN RAILWAY SERVICE OF MECHANICAL ENGINEERS 2
INDIAN RAILWAY STORE SERVICE (MECHANICAL ENGG POSTS) 1
CENTRAL ELECTRICAL AND MECHANICAL ENGINEERING SERVICE(MECHANICAL ENGG. POSTS) 4
DEFENCE AERONAUTICAL QUALITY ASSURANCE SERVICE/SSO-II (MECHANICAL) 5
AEE IN GEOLOGICAL SURVEY OF INDIA ENGINEERING SERVICE. GR. A 9
INDIAN DEFENCE SERVICE OF ENGINEERS 3
INDIAN NAVAL ARMAMENT SERVICE(MECHANICAL ENGINEERING POSTS) 7
ASSISTANT NAVAL STORE OFFICER GRADE-I(MECHANICAL ENGINEERING POSTS) IN INDIAN NAVY 6
AEE(MECH) IN BORDER ROADS ENGINEERING SERVICE 8

Note 1 : No request for addition/alteration in the preferences indicated by a candidate in this application
form will be entertained by the commission.

Note 2 : Candidate is advised to indicate all the Services/Posts (as given in para 2 of Notice) for which he is eligible
in terms of the Rules in the order of preferences in Col. 17 of his/her application form.In case he/she does not give
any preference for any Services/Posts or does not include certain Services/Posts in Col. 17 of the application form,
it will be assumed that he/she has no specific preference for these Services/Posts and in that event he/she shall be
allocated to any of the remaining Services/Posts in the order as appearing in the notification and in which there are
vacancies after allocation of candidates according to the Services/Posts of their preference.

18. Whether you have applied for/been

selected for U.P.S.C. Examination
/Recruitments earlier:- | YES

Roll No. :- 0405874 | This is a Printout of "PREVIEW OF THE FORM".There is no need to send the Printout to the
commission.However, candidate may take a printout after final submission for future reference only.
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Details of other application for Examination/Recruitment held/to be held by UPSC :-
Name of Examination/ Month and year of Roll. No. Whether you appeared Whether you were
Recruitment Examination /Name at the recommended for
of the Post for Examination/Interview appointment
Recruitment
Engineering Services 01-7-2018 -ESE 0838120 YES NO
MAINS

19. Have you ever been debarred by

any Public Service Commission
or SSC from any of their
Examinations/Selections? | NO

20. Please give Particulars of:-

(a) Prizes,medals scholarships,etc that | DESIGNED SUSPENSION IN SAE-2014

you have been awarded. WHEREBY SECURED AIR 30 RANK IN VIRTUAL
ROUND. I ALSO SECURED 3RD RANK IN
STEERING ROUND IN ESVC- 2013 GO-KART
COMPETITION AND OBTAINED 183 AIR RANK
IN GATE-2019.
(b) Team Games / Sports / N.C.C. / | I OFTEN PLAY BADMINTON INORDER TO
Mountaineering etc. INCREASE CARDIOVASCULAR FITNESS AND
ENHANCE MUSCULAR FITNESS AND
FLEXIBILITY.
(c) Position(s) of distinction /leadership | SPEARHEADED THE SUSPENSION
held in School/College DEPARTMENT IN BOTH SAE 2014 AND ESVC
WHILE COORDINATING WITH TEAM,
ORGANISED SAE WORKSHOPS. I WAS
COORDINATOR FOR PRE-PLACEMENT
PROGRAM IN MY FINAL YEAR FOR
GROOMING 3-RD YEAR STUDENTS.
(d) Other extra curricular activities and | NET- SURFING TO KEEP MYSELF BOTH
interests (Such as hobbies etc.) INFORMED,UPDATED AND ENTERTAINED.

21. Person with Benchmark

Disability | NO

22. List of scanned copies uploaded by the candidate:-

--->A Scanned Copy of certificate of Age.
--->A Scanned copy of the certificates showing his/her educational qualification prescribed in para 3(iii) of
the Notice of the Examination uploaded on the website of Commission and Rule 6 of the Rules of
Examination published in the Gazette of India dated 26th September, 2018.
--->Any of the following photo ID proofs (Viz. Aadhar card, Voter card, PAN card, Passpost, Driving
License, Educational Institution/Office ID Card or any other photo ID issued by Central/State Government).

Roll No. :- 0405874 | This is a Printout of "PREVIEW OF THE FORM".There is no need to send the Printout to the
commission.However, candidate may take a printout after final submission for future reference only.
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