Scribd Logo
Upload

Welcome to Scribd!

  • 5 views

    Application Form Draft Print For All

    Uploaded by

    Muthu Emm Ess
    ApplicationFormDraftPrintForAll

    Copyright:

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

    Application Form Draft Print For All

    Uploaded by

    Muthu Emm Ess
    5 views3 pages
    ApplicationFormDraftPrintForAll

    Original Title

    ApplicationFormDraftPrintForAll

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    ApplicationFormDraftPrintForAll

    Copyright:

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

    Application Form Draft Print For All

    Uploaded by

    Muthu Emm Ess
    ApplicationFormDraftPrintForAll

    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), SSF AND RIFLEMAN (GD) IN ASSAM RIFLES
    EXAMINATION 2024

    REGISTRATION NO: 10003812443

    APPLICATION IS INCOMPLETE

    1. NAME AS PER MATRICULATION 2. NEW/CHANGED


    3. FATHER'S NAME 4. MOTHER'S NAME
    CERTIFICATE NAME
    UDHAYAKUMAR GOVINDAN - GOVINDAN LAKSHMI
    5. DATE OF BIRTH (DD/MM/YYYY) 6. AGE AS ON 01/01/2024 7. GENDER 8. CATEGORY
    29/09/1999 24.3 MALE OBC
    9. NATIONALITY 10. MARK OF VISIBLE IDENTIFICATION
    CITIZEN OF INDIA A SCAR ON THE NOUS
    12. MATRICULATION (10th 13. MATRICULATION (10th
    11. MATRICULATION (10th CLASS) EXAMINATION BOARD
    CLASS) ROLL NO CLASS) YEAR OF PASSING
    TAMIL NADU BOARD OF SECONDARY EDUCATION 2222013 2014
    14.1. WHETHER YOU ARE AN EX-SERVICEMEN (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 THE ARMED FORCES
    (DD/MM/YYYY)
    - -
    14.5. HAVE YOU ALREADY JOINED A CIVIL POST BY
    AVAILING BENEFIT OF RESERVATION FOR EX-SERVICEMEN 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
    YES 02-OBC
    16.1. ARE YOU A NATIONAL CADET CORPS (NCC)
    16.2. TYPE OF THE NCC CERTIFICATE
    CERTIFICATE HOLDER
    NO -
    17. PREFERENCE OF EXAMINATION CENTRES

    EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER


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

    SALEM ( 8205 ) COIMBATORE ( 8202 ) VELLORE ( 8208 )

    18. MEDIUM FOR COMPUTER BASED 19. STATE/ UT OF DOMICILE 20. DISTRICT OF DOMICILE
    EXAMINATION (CBE)
    TAMIL TAMIL NADU DHARMAPURI
    21.1. HAVE YOU MIGRATED FROM THE STATE/ UT OF 21.2. WHETHER YOU WOULD LIKE TO AVAIL THE BENEFIT OF
    YOUR ORIGIN TO ANOTHER STATE/ UT RESERVATION FROM THE STATE/ UT OF YOUR ORIGIN
    NO -
    21.3. STATE/ UT OF ORIGIN 21.4. DISTRICT OF ORIGIN
    - -
    22. CANDIDATE BELONGS TO MILITANCY/ NAXAL
    23. CANDIDATE BELONGS TO BORDER DISTRICT
    AFFECTED DISTRICT
    NO NO
    24. PREFERENCE OF POST FOR CAPF(S)/ ORGANIZATION(S)
    A,B,D,E,F,C,H,
    25. HIGHEST EDUCATIONAL QUALIFICATION
    M. SC. (27)
    26. DETAILS OF QUALIFYING EDUCATION
    10TH STANDARD
    STATUS PASSING STATE/ UT OF BOARD/ NAME OF BOARD/ ROLL NO PERCENTAGE CGPA
    YEAR UNIVERSITY UNIVERSITY
    PASSED 2014 TAMIL NADU TAMIL NADU BOARD 2222013 70.5 -
    OF SECONDARY
    EDUCATION
    27. 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
    28. CORRESPONDENCE ADDRESS 29. PERMANENT ADDRESS
    2/38 BATRAHALLI PETHANAHALLI POST P SETTIHALLI 2/38 BATRAHALLI PETHANAHALLI POST P SETTIHALLI
    PALACODE DHARMAPURI-636808 PALACODE DHARMAPURI-636808
    DISTRICT: DHARMAPURI DISTRICT: DHARMAPURI
    STATE: TAMIL NADU STATE: TAMIL NADU
    PIN: 636808 PIN: 636808
    MOBILE NO. : 7397571722 EMAIL ID: [email protected]
    30. WHETHER PHOTOGRAPH HAS BEEN TAKEN ON OR AFTER 24-AUGUST-2023?
    YES
    FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE

    NOT EXEMPTED 100 - -


    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: 22/12/2023 8:45:18 PM IP ADDRESS: 106.216.162.231

    You might also like