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    SSC Model Application

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    Anbarasan Muthaiah
    This document is a registration application provisionally accepted for the Junior Engineer (Civil, Electrical, Mechanical and Quantity Surveying & Contracts) Examination 2018. It contains the applicant's personal details such as name, father's name, date of birth, gender, nationality, address, qualification details, exam preferences and declaration of truth of information provided. The applicant is Anbarasan M from Tamil Nadu applying for the Junior Engineer (Civil) post seeking age relaxation under OBC category.

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    © All Rights Reserved
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    SSC Model Application

    Uploaded by

    Anbarasan Muthaiah
    125 views2 pages
    This document is a registration application provisionally accepted for the Junior Engineer (Civil, Electrical, Mechanical and Quantity Surveying & Contracts) Examination 2018. It contains the applicant's personal details such as name, father's name, date of birth, gender, nationality, address, qualification details, exam preferences and declaration of truth of information provided. The applicant is Anbarasan M from Tamil Nadu applying for the Junior Engineer (Civil) post seeking age relaxation under OBC category.

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    Ssc je

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    Ssc model application

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    This document is a registration application provisionally accepted for the Junior Engineer (Civil, Electrical, Mechanical and Quantity Surveying & Contracts) Examination 2018. It contains the applicant's personal details such as name, father's name, date of birth, gender, nationality, address, qualification details, exam preferences and declaration of truth of information provided. The applicant is Anbarasan M from Tamil Nadu applying for the Junior Engineer (Civil) post seeking age relaxation under OBC category.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    125 views2 pages

    SSC Model Application

    Uploaded by

    Anbarasan Muthaiah
    This document is a registration application provisionally accepted for the Junior Engineer (Civil, Electrical, Mechanical and Quantity Surveying & Contracts) Examination 2018. It contains the applicant's personal details such as name, father's name, date of birth, gender, nationality, address, qualification details, exam preferences and declaration of truth of information provided. The applicant is Anbarasan M from Tamil Nadu applying for the Junior Engineer (Civil) post seeking age relaxation under OBC category.

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    STAFF SELECTION COMMISSION

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


    110003
    JUNIOR ENGINEER (CIVIL, ELECTRICAL,
    MECHANICAL AND QUANTITY SURVEYING &
    CONTRACTS) EXAMINATION 2018
    REGISTRATION NO: 81000217308

    APPLICATION IS PROVISIONALLY ACCEPTED


    1. NAME AS PER 2. NEW/CHANGED 3. FATHER'S NAME 4. MOTHER'S NAME
    MATRICULATION NAME
    CERTIFICATE
    ANBARASAN M - MUTHAIAH R MALARKODI M
    5. DATE OF BIRTH (DD/MM/YYYY) 6. AGE AS ON 01/08/2019 7. GENDER
    06/05/1991 28.3 MALE
    10. MARK OF VISIBLE
    8. CATEGORY 9. NATIONALITY
    IDENTIFICATION
    A SMALL BLACK MOLE ON
    OBC CITIZEN OF INDIA
    AND ABOVE THE CHEST
    11. MATRICULATION (10th CLASS) EXAMINATION 12. MATRICULATION (10th 13. MATRICULATION (10th
    BOARD CLASS) ROLL NO CLASS) YEAR OF PASSING
    TAMIL NADU BOARD OF SECONDARY EDUCATION 151079 2006
    14. PREFERENCE OF EXAMINATION CENTERS
    EXAMINATION CENTER ( FIRST ) EXAMINATION CENTER ( SECOND ) EXAMINATION CENTER ( THIRD )

    TIRUCHIRAPALLI ( 8206 ) MADURAI ( 8204 ) PUDUCHERRY ( 8401 )


    15.WHETHER EX- 15.1. HAVE YOU ALREADY 15.2. LENGTH OF SERVICE IN 15.3. DATE OF DISCHARGE
    SERVICEMAN (ESM)? JOINED A CIVIL POST BY ARMED FORCES ( IN YEARS ) FROM ARMED FORCES
    AVAILING BENEFIT OF (DD/MM/YYYY)
    RESERVATION FOR EX-
    SERVICEMAN (ESM) :?
    NO - - -
    16. WHETHER PERSON WITH DISABILITY 16.1 IF YES, TYPE OF DISABILITY (OH, HH,VH, OTHERS)
    (PWD) ?
    NO -
    17. 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)?
    NO
    17.1 WHETHER SCRIBE IS REQUIRED 17.2 WILL YOU MAKE YOUR OWN 17.3 IF SCRIBE IS TO BE
    ARRANGEMENT OF SCRIBE? ARRANGED BY SSC, INDICATE
    MEDIUM
    NO - -
    18. WHETHER SEEKING AGE RELAXATION? 18.1 IF YES,INDICATE CODE
    YES 02-OBC
    19. POST(S) APPLYING FOR 20. MEDIUM FOR PAPER II
    19. POST(S) APPLYING FOR 20. MEDIUM FOR PAPER II
    JUNIOR ENGINEER(CIVIL) ENGLISH
    21. QUALIFICATION DETAILS
    HIGHEST TECHNICAL QUALIFICATION RELEVANT TO SUBJECT
    THE POST OF INTEREST
    BE CIVIL ENGINEERING
    22. DO YOU BELONG TO ECONOMICALLY WEAKER SECTIONS (EWS) ?
    -
    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. POSTAL ADDRESS 25. PERMANENT ADDRESS
    VAIKKALPARAI KOVILPARAI POST ANDIPATTI TALUK VAIKKALPARAI KOVILPARAI POST ANDIPATTI TALUK

    DISTRICT: THENI DISTRICT:THENI


    STATE: TAMIL NADU STATE: TAMIL NADU
    PIN : 625579 PIN : 625579
    MOBILE NO: 9715067010 EMAIL: anbuforsuccess@gmail.com
    SIGNATURE THUMB IMPRESSION

    FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE


    NOT EXEMPTED 100 CPN4930970 16/02/2019
    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: 21/07/2019 7:00:36 PM

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