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    Applicationform Draft Print For All

    Uploaded by

    alkapannalal

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Applicationform Draft Print For All

    Uploaded by

    alkapannalal
    7 views3 pages

    Original Title

    Applicationform Draft Print for All

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

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

    Applicationform Draft Print For All

    Uploaded by

    alkapannalal

    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

    CONSTABLES (GD) IN CENTRAL ARMED POLICE FORCES


    (CAPFs), NIA, SSF AND RIFLEMAN (GD) IN ASSAM
    RIFLES EXAMINATION, 2021

    REGISTRATION NO: 20003091003

    APPLICATION IS PROVISIONALLY ACCEPTED

    1. NAME AS PER MATRICULATION 2. NEW/CHANGED


    3. FATHER'S NAME 4. MOTHER'S NAME
    CERTIFICATE NAME
    ALKA - PANNA LAL VIMLA RANI
    6. AGE AS ON
    5. DATE OF BIRTH (DD/MM/YYYY) 7. GENDER 8. CATEGORY
    01/08/2021
    30/04/2003 18.3 FEMALE SC
    9. NATIONALITY 10. MARK OF VISIBLE IDENTIFICATION
    CITIZEN OF INDIA NO MARK
    12. MATRICULATION (10th 13. MATRICULATION (10th
    11. MATRICULATION (10th CLASS) EXAMINATION BOARD
    CLASS) ROLL NO CLASS) YEAR OF PASSING
    BOARD OF SECONDARY EDUCATION, RAJASTHAN 2151562 2019
    14.1. WHETHER YOU ARE AN EX-SERVICEMAN (ESM) OR
    14.2. DATE OF JOINING THE ARMED FORCES (DD/MM/YYYY)
    SERVING IN THE ARMED FORCES?
    NO -
    14.3. DATE OF DISCHARGE FROM ARMED FORCES
    14.4. LENGTH OF SERVICE IN ARMED FORCES
    (DD/MM/YYYY)
    - -
    14.5. HAVE YOU ALREADY JOINED A CIVIL POST BY
    AVAILING BENEFIT OF RESERVATION FOR EX-SERVICEMAN 14.6. DATE OF JOINING TO CIVIL POST (DD/MM/YYYY)
    (ESM) ?
    - -
    15.1. WHETHER SEEKING AGE RELAXATION? 15.2 IF YES, AGE RELAXATION CODE
    NO -
    16.1. ARE YOU A NATIONAL CADET CORPS (NCC)
    16.2. TYPE OF THE NCC CERTIFICATE
    CERTIFICATE HOLDER
    NO -
    17. PREFERENCE OF EXAMINATION CENTERS

    EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER


    ( FIRST PREFERENCE ) ( SECOND PREFERENCE) ( THIRD PREFERENCE)

    SRIGANGANAGAR ( 2408 ) BIKANER ( 2404 ) SIKAR ( 2411 )

    18. STATE/ UT OF DOMICILE 19. DISTRICT OF DOMICILE

    RAJASTHAN SRI GANGANAGAR


    20.1. HAVE YOU MIGRATED FROM THE STATE/ UT OF 20.2. WHETHER YOU WOULD LIKE TO AVAIL THE BENEFIT OF
    YOUR ORIGIN TO ANOTHER STATE/ UT RESERVATION FROM THE STATE/ UT OF YOUR ORIGIN
    NO -
    20.3. STATE/ UT OF ORIGIN 20.4. DISTRICT OF ORIGIN
    - -
    21. CANDIDATE BELONGS TO MILITANCY/ NAXAL
    22. CANDIDATE BELONGS TO BORDER DISTRICT
    AFFECTED DISTRICT
    NO YES
    23. PREFERENCE OF POST FOR CAPF(S)/ ORGANIZATION(S)
    A,D,H,B,E,F
    24. HIGHEST EDUCATIONAL QUALIFICATION
    MATRICULATION/ 10TH CLASS PASS(1)
    25. DETAILS OF QUALIFYING EDUCATION
    10TH STANDARD
    STATUS PASSING STATE/ UT OF BOARD/ NAME OF BOARD/ ROLL NO PERCENTAGE CGPA
    YEAR UNIVERSITY UNIVERSITY
    PASSED 2019 RAJASTHAN BOARD OF 2151562 57.83 -
    SECONDARY
    EDUCATION,
    RAJASTHAN
    26. 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
    27. CORRESPONDENCE ADDRESS 28. PERMANENT ADDRESS
    WARD NO 04 WARD NO 04
    VPO GOVINDPURA VPO GOVINDPURA
    18 GG 18 GG
    DISTRICT: SRI GANGANAGAR DISTRICT: SRI GANGANAGAR
    STATE: RAJASTHAN STATE: RAJASTHAN
    PIN: 335002 PIN: 335002
    MOBILE NO. : 7737672205 EMAIL ID: [email protected]
    29. DATE ON WHICH PHOTOGRAPH HAS BEEN TAKEN 30. WHETHER THE DATE OF PHOTOGRAPH IS CLEARLY
    (DD/MM/YYYY): PRINTED ON THE PHOTOGRAPH

    01/08/2021 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: 02/08/2021 10:16:06 AM IP ADDRESS: 157.38.123.218

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