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    MTS Havaldar Form2022

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    New Global
    The document is an application form submitted by Shiva Ji for the Multi Tasking (Non-Technical) Staff, and Havaldar (CBIC & CBN) Examination, 2022 conducted by the Staff Selection Commission. It contains personal details of the applicant such as name, father's name, date of birth, gender, category, address, education details, photograph details, center preference and declaration.

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    © All Rights Reserved
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    MTS Havaldar Form2022

    Uploaded by

    New Global
    27 views3 pages
    The document is an application form submitted by Shiva Ji for the Multi Tasking (Non-Technical) Staff, and Havaldar (CBIC & CBN) Examination, 2022 conducted by the Staff Selection Commission. It contains personal details of the applicant such as name, father's name, date of birth, gender, category, address, education details, photograph details, center preference and declaration.

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    © © All Rights Reserved

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    The document is an application form submitted by Shiva Ji for the Multi Tasking (Non-Technical) Staff, and Havaldar (CBIC & CBN) Examination, 2022 conducted by the Staff Selection Commission. It contains personal details of the applicant such as name, father's name, date of birth, gender, category, address, education details, photograph details, center preference and declaration.

    Copyright:

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

    MTS Havaldar Form2022

    Uploaded by

    New Global
    The document is an application form submitted by Shiva Ji for the Multi Tasking (Non-Technical) Staff, and Havaldar (CBIC & CBN) Examination, 2022 conducted by the Staff Selection Commission. It contains personal details of the applicant such as name, father's name, date of birth, gender, category, address, education details, photograph details, center preference and declaration.

    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
    MULTI TASKING (NON-TECHNICAL) STAFF, AND
    HAVALDAR (CBIC & CBN) EXAMINATION, 2022
    REGISTRATION NO: 30006319463
    APPLICATION RECEIVED (CONTENTS NOT VERIFIED)
    1. NAME AS PER MATRICULATION 2. NEW/CHANGED
    CERTIFICATE 3. FATHER'S NAME 4. MOTHER'S NAME
    NAME
    SHIVA JI - GHURHU PRASAD GEETA DEVI
    6. AGE AS ON
    5. DATE OF BIRTH (DD/MM/YYYY) 7. GENDER 8. CATEGORY
    01/01/2023
    01/08/1995 27.5 MALE SC
    9. WHETHER PERSON WITH DISABILITY (PwD)? 9.1 IF YES, TYPE OF DISABILITY
    NO -
    10. NATIONALITY 11. MARK OF VISIBLE IDENTIFICATION
    CITIZEN OF INDIA MOLE ON FACE
    13. MATRICULATION (10th 14. MATRICULATION (10th
    12. MATRICULATION (10th CLASS) EXAMINATION BOARD
    CLASS) ROLL NO CLASS) YEAR OF PASSING
    BOARD OF HIGH SCHOOL AND INTERMEDIATE
    3741351 2012
    EDUCATION UTTAR PRADESH
    15. PREFERENCE OF EXAMINATION CENTERS
    EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER
    ( FIRST PREFERENCE ) ( SECOND PREFERENCE ) ( THIRD PREFERENCE )
    VARANASI ( 3013 ) LUCKNOW ( 3010 ) PRAYAGRAJ ( 3003 )

    16. MEDIUM FOR COMPUTER BASED EXAMINATION(CBE)

    HINDI (1)
    17.1. WHETHER YOU ARE AN EX- 17.3.DATE OF DISCHARGE/ LIKELY DATE
    17.2. DATE OF JOINING THE ARMED
    SERVICEMAN (ESM) OR SERVING OF DISCHARGE FROM ARMED FORCES
    FORCES (DD/MM/YYYY)
    IN THE ARMED FORCES? (DD/MM/ YYYY)
    NO - -
    17.5. HAVE YOU ALREADY JOINED A
    17.4. LENGTH OF SERVICE IN THE CIVIL POST BY AVAILING BENEFIT OF 17.6. DATE OF JOINING TO CIVIL POST
    ARMED FORCES RESERVATION FOR EX-SERVICEMAN (DD/MM/YYYY)
    (ESM) ?
    - - -
    18.1 ARE YOU A PERSON WITH BENCHMARK DISABILITIES (i.e. 40% OR MORE) IN THE FOLLOWING CATEGORIES:
    (i) BLINDNESS (VH) AND/OR
    (ii) BOTH ARMS AFFECTED (BA) AND/OR
    (iii) CEREBRAL PALSY (CP)?
    -
    18.2 DO YOU HAVE A PHYSICAL LIMITATION TO WRITE AS PER PARA 8.2 AND 8.3 OF THE NOTICE?
    -
    18.3 WHETHER SCRIBE IS REQUIRED 18.4 WILL YOU MAKE YOUR OWN 18.5 IF SCRIBE IS TO BE
    ARRANGEMENT OF SCRIBE? ARRANGED BY SSC, INDICATE
    MEDIUM
    - - -
    19.1. WHETHER SEEKING AGE RELAXATION? 19.2. IF YES,INDICATE CODE
    YES 01-SC/ST
    20. STATE(S) / U.T.(S) / CCA(S) PREFERENCE CODE
    25,24,21,22,23,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65
    ,66,67,68,69,70,71,72,11,12,13,14,15,16,17,18,19,20
    21. HIGHEST EDUCATIONAL QUALIFICATION
    MATRICULATION/ 10TH CLASS PASS (1)
    22. DETAILS OF QUALIFYING EDUCATION
    10TH STANDARD
    STATUS PASSING STATE/ UT OF BOARD/ NAME OF BOARD/ ROLL NO PERCENTAGE CGPA
    YEAR UNIVERSITY UNIVERSITY
    PASSED 2012 UTTAR PRADESH BOARD OF HIGH 3741351 61 -
    SCHOOL AND
    INTERMEDIATE
    EDUCATION UTTAR
    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
    VILL ATAYASTGANJ POST SHAHABAGANJ CHAKIA DISST VILL ATAYASTGANJ POST SHAHABAGANJ CHAKIA DISST
    CHANDAULI CHANDAULI
    DISTRICT: CHANDAULI DISTRICT: CHANDAULI
    STATE: UTTAR PRADESH STATE: UTTAR PRADESH
    PIN: 232118 PIN: 232118
    MOBILE NO. : 9120221975 EMAIL ID: sivaji.232118@gmail.com
    26. WHETHER THE PHOTOGRAPH HAS BEEN TAKEN ON OR AFTER 18-OCT-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: 07/02/2023 6:00:45 PM IP ADDRESS: 47.9.72.111

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