Scribd
Upload
44 views3 pages

Applicationform Draft Print For All

Anushka Singh has been provisionally accepted to appear for the Combined Graduate Level Examination, 2020. She is a 23 year old female from Uttar Pradesh with a B.Sc. degree. Her first preference for examination center is Agra, second preference is Kanpur, and third preference is Lucknow. She declares that all information provided in her application is true and correct.

Uploaded by

Anushka Singh
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
44 views3 pages

Applicationform Draft Print For All

Anushka Singh has been provisionally accepted to appear for the Combined Graduate Level Examination, 2020. She is a 23 year old female from Uttar Pradesh with a B.Sc. degree. Her first preference for examination center is Agra, second preference is Kanpur, and third preference is Lucknow. She declares that all information provided in her application is true and correct.

Uploaded by

Anushka Singh
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
You are on page 1/ 3

STAFF SELECTION COMMISSION

BLOCK NO. 12, CGO-COMPLEX, LODHI ROAD, NEW DELHI


110003

COMBINED GRADUATE LEVEL EXAMINATION, 2020

REGISTRATION NO: 93000073370

APPLICATION IS PROVISIONALLY ACCEPTED

1. NAME AS PER 2. NEW/ CHANGED 3. FATHER'S NAME 4. MOTHER'S NAME


MATRICULATION CERTIFICATE NAME

ANUSHKA SINGH - JAY SINGH ANEETA SINGH


6. AGE AS ON
5. DATE OF BIRTH (DD/MM/YYYY) 7. GENDER 8. CATEGORY
01/01/2021
14/09/1997 23.3 FEMALE SC
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 RIGHT HAND THUMB
12. MATRICULATION (10th CLASS) EXAMINATION 13. MATRICULATION (10th 14. MATRICULATION (10th
BOARD CLASS) ROLL NO CLASS) YEAR OF PASSING
BOARD OF HIGH SCHOOL AND INTERMEDIATE
0143944 2011
EDUCATION UTTAR PRADESH
15. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER
(FIRST PRFERENCE ) (SECOND PREFERENCE ) (THIRD PREFERENCE )
AGRA ( 3001 ) KANPUR ( 3009 ) LUCKNOW ( 3010 )
16.2. LENGTH OF SERVICE 16.3. DATE OF DISCHARGE FROM ARMED FORCES
16.1. WHETHER EX-
IN THE ARMED FORCES (IN (DD/MM/YYYY)
SERVICEMAN (ESM) ?
YEARS)
NO - -
16.4. HAVE YOU ALREADY JOINED A CIVIL POST BY
AVAILING BENEFIT OF RESERVATION FOR EX- 16.5. DATE OF JOINING THE CIVIL POST (DD/MM/YYYY)
SERVICEMAN (ESM) ?
- -
17. 1. WHETHER SUFFERING FROM CEREBRAL-PALSY ?
-
17.2. 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) ?
-
17.3. WHETHER SCRIBE IS REQUIRED ? 17.4. WILL YOU MAKE YOUR OWN 17.5. IF SCRIBE IS TO BE ARRANGED
ARRANGEMENT OF SCRIBE ? BY SSC, INDICATE MEDIUM
- - -
18. ARE YOU ALSO APPLYING FOR THE POST OF JUNIOR 19. DO YOU POSSESS EQ FOR THE POST OF JUNIOR
STATISTICAL OFFICER (MoSPI)? STATISTICAL OFFICER (MoSPI)?
NO -
20. WHETHER SEEKING AGE RELAXATION ? 20.1 IF YES, AGE RELAXATION CODE
NO -
21. HIGHEST EDUCATIONAL QUALIFICATION
B.SC. (9)
22. DETAILS OF QUALIFYING EDUCATIONAL QUALIFICATION
GRADUATION
STATE/ UT OF
PASSING NAME OF
STATUS BOARD/ ROLL NO PERCENTAGE CGPA
YEAR BOARD/ UNIVERSITY
UNIVERSITY
DR. B.R. AMBEDKAR
PASSED 2016 UTTAR PRADESH UNIVERSITY UTTAR 160240061054 58.05 -
PRADESH
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 ?
YES
ADDRESS DETAIL
24. CORRESPONDENCE ADDRESS 25. PERMANENT ADDRESS
HOUSE NO.24 DEVPURA MAINPURI HOUSE NO.24 DEVPURA MAINPURI

DISTRICT: MAINPURI DISTRICT:MAINPURI


STATE: UTTAR PRADESH STATE: UTTAR PRADESH
PIN : 205001 PIN : 205001
MOBILE NO: 9760927083 EMAIL: [email protected]
27. DATE ON WHICH THE UPLOADED PHOTOGRAPH 28. WHETHER THE DATE OF PHOTOGRAPH IS CLEARLY
HAS BEEN TAKEN PRINTED ON THE PHOTOGRAPH
(DD/MM/YYYY):
04/01/2021 YES
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
EXEMPTED - - -
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: 04/01/2021 6:17:29 PM IP ADDRESS:132.154.125.95

You might also like