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    SSC CHSL Form 2022

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    shirisha
    This document contains an application form submitted by Ariyaram Shirisaha for the Combined Higher Secondary (10+2) Level Examination, 2022 conducted by the Staff Selection Commission. The form provides personal details of the applicant such as name, father's name, date of birth, gender, category, address, qualification details, photograph details, and a declaration signed by the applicant agreeing to the terms and conditions of the examination.

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    © All Rights Reserved
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    SSC CHSL Form 2022

    Uploaded by

    shirisha
    94 views3 pages
    This document contains an application form submitted by Ariyaram Shirisaha for the Combined Higher Secondary (10+2) Level Examination, 2022 conducted by the Staff Selection Commission. The form provides personal details of the applicant such as name, father's name, date of birth, gender, category, address, qualification details, photograph details, and a declaration signed by the applicant agreeing to the terms and conditions of the examination.

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    SSC Chsl Form 2022

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    This document contains an application form submitted by Ariyaram Shirisaha for the Combined Higher Secondary (10+2) Level Examination, 2022 conducted by the Staff Selection Commission. The form provides personal details of the applicant such as name, father's name, date of birth, gender, category, address, qualification details, photograph details, and a declaration signed by the applicant agreeing to the terms and conditions of the examination.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    94 views3 pages

    SSC CHSL Form 2022

    Uploaded by

    shirisha
    This document contains an application form submitted by Ariyaram Shirisaha for the Combined Higher Secondary (10+2) Level Examination, 2022 conducted by the Staff Selection Commission. The form provides personal details of the applicant such as name, father's name, date of birth, gender, category, address, qualification details, photograph details, and a declaration signed by the applicant agreeing to the terms and conditions of the examination.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    STAFF SELECTION COMMISSION

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


    110003
    COMBINED HIGHER SECONDARY (10+2) LEVEL
    EXAMINATION, 2022

    REGISTRATION NO: 10001549261

    APPLICATION RECEIVED (CONTENTS NOT VERIFIED)

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


    ARIYARAM SHIRISHA - ARIYARAM SRINIVASULU ARIYARAM DORASANI
    5. DATE OF BIRTH (DD/MM/YYYY) 6. AGE AS ON 01/01/2022 7. GENDER 8. CATEGORY
    24/07/2000 21.5 FEMALE OBC
    9. WHETHER PERSON WITH DISABILITY (PwBD) ? 9.1 IF YES, TYPE OF DISABILITY (OH, HH,VH, OTHERS)

    NO -

    10. NATIONALITY 11. MARK OF VISIBLE IDENTIFICATION


    CITIZEN OF INDIA A MOLE ON RIGHT FORE ARM
    13. MATRICULATION (10th 14. MATRICULATION (10th
    12. MATRICULATION (10th CLASS) EXAMINATION BOARD
    CLASS) ROLL NO CLASS) YEAR OF PASSING
    BOARD OF SECONDARY EDUCATION ANDHRA PRADESH 1516134859 2015
    15. PREFERENCE OF EXAMINATION CENTERS
    EXAMINATION CENTRE EXAMINATION CENTRE EXAMINATION CENTRE
    (FIRST PREFERENCE ) (SECOND PREFERENCE ) (THIRD PREFERENCE)
    VIJAYWADA ( 8008 ) GUNTUR ( 8001 ) NELLORE ( 8010 )
    17. WHETHER 12TH STANDARD PASS IN SCIENCE STREAM WITH
    16. MEDIUM FOR TYPING TEST: MATHEMATICS AS A SUBJECT FROM A RECOGNIZED BOARD OR EQUIVALENT
    (FOR C&AG AS DATA ENTRY OPERATOR):
    ENGLISH YES
    18.1. WHETHER YOU ARE AN EX- 18.2. DATE OF JOINING THE ARMED 18.3.DATE OF DISCHARGE/ LIKELY
    SERVICEMAN (ESM) OR SERVING IN FORCES (DD/MM/YYYY) DATE OF DISCHARGE FROM ARMED
    THE ARMED FORCES? FORCES (DD/MM/ YYYY)

    NO - -
    18.4. LENGTH OF SERVICE IN THE 18.5. HAVE YOU ALREADY JOINED A 18.6. DATE OF JOINING TO CIVIL POST
    ARMED FORCES CIVIL POST BY AVAILING BENEFIT OF (DD/MM/YYYY)
    RESERVATION FOR EX-SERVICEMAN
    (ESM) ?
    - - -
    19.1.ARE YOU A PERSON WITH BENCHMARK DISABILITIES (i.e. 40% OR MORE) IN THE CATEGORY OF BLINDNESS,
    BOTH ARMS AFFECTED- BA AND/ OR 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) ?
    -
    19.3. WHETHER SCRIBE IS REQUIRED ? 19.4. WILL YOU MAKE YOUR OWN 19.5. IF SCRIBE IS TO BE ARRANGED
    ARRANGEMENT OF SCRIBE ? BY SSC, INDICATE MEDIUM
    - - -

    20.1. WHETHER SEEKING AGE RELAXATION ? 20.2. IF YES, AGE RELAXATION CODE

    NO
    -
    21. HIGHEST EDUCATIONAL QUALIFICATION
    BA (HONS.) (6)
    22. DETAILS OF QUALIFYING EDUCATIONAL QUALIFICATION
    12TH STANDARD
    STATE/ UT OF NAME OF BOARD/
    STATUS PASSING YEAR ROLL NO PERCENTAGE CGPA
    BOARD/ UNIVERSITY UNIVERSITY
    BOARD OF
    SECONDARY
    PASSED 2017 ANDHRA PRADESH EDUCATION 1707235093 66.6 -
    ANDHRA
    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 ?
    NO
    ADDRESS DETAIL
    24. CORRESPONDENCE ADDRESS 25. PERMANENT ADDRESS
    DOOR NO 1-300 SEETHARAM THOTA PAMUR PAMUR POST DOOR NO 1-300 SEETHARAM THOTA PAMUR PAMUR POST
    AND MANDAL PRAKASAM DT AND MANDAL PRAKASAM DT
    DISTRICT: PRAKASAM DISTRICT:PRAKASAM
    STATE: ANDHRA PRADESH STATE: ANDHRA PRADESH
    PIN : 523108 PIN : 523108
    MOBILE NO: 9030784614 EMAIL: [email protected]
    27. WHETHER THE PHOTOGRAPH HAS BEEN TAKEN ON OR AFTER 06-SEPTEMBER-2022?
    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.

    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 AADHAR DATA FOR VERIFICATION PURPOSE.


    PRINT TAKEN ON: 31/12/2022 10:55:32 AM IP ADDRESS: 49.43.200.119

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