HLL DGHS

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APPLICATION FORM :

PERSONAL INFORMATION

APPLICATION NO. : 169672

APPLYING FOR: COOK-CUM-KITCHEN


ASSISTANT(RLTRI, GOURIPUR)

FEE AMOUNT: ₹ 0.00

NAME: ROSHAN KUMAR DAS

DATE OF BIRTH: 24-01-1999

FATHER/GUARDIAN NAME: TIJU RAVIDAS

MOTHER NAME: SURTI DEVI

MOBILE NUMBER: 9693370755

EMAIL ID: ROSHANKUMARDAS755@GMAIL.COM

GENDER: MALE

AADHAR NUMBER: 956402107167

MARITAL STATUS: UNMARRIED

CATEGORY: SCHEDULED CASTE

SUB CATEGORY NONE

NATIONALITY INDIAN

CURRENT ADDRESS: AT-KAITHA,PO-RAMGARH,PS-


ADDRESS:
RAMGARH, DISTRICT-RAMGARH
STATE/U.T.: JHARKHAND (JH)
CITY: RAMGARH
PINCODE: 829122
PERMANENT ADDRESS: AT-KAITHA,PO-RAMGARH,PS-
ADDRESS:
RAMGARH, DISTRICT-RAMGARH
STATE/U.T.: JHARKHAND (JH)
CITY: RAMGARH
PINCODE: 829122

EXAM CITIES: EXAM CITY 1: RANCHI


EXAM CITY 2: KOLKATA
EXAM CITY 3: LUCKNOW

EDUCATION DETAILS
EXAMINATION BOARD/UNIVERSITY/ STREAM/SUBJECT YEAR OF PERCENTAGE
INSTITUTE PASSING

MATRICULATION OR EQUIVALENT QUALIFICATION FROM A RECOGNIZED BOARD,

*10TH / MATRIC UPGRADE HIGH HIN, MAY-2016 41.8


/ EQUIVALENT SCHOOL KAITHA ENG,MAT,SOC,SC,SNK

2 YEAR EXPERIENCE OF WORKING IN THE PROFESSION FROM GOVERNMENT/SEMI


GOVERNMENT INSTITUTIONS
2 YEAR EXPERIENCE OF WORKING IN THE PROFESSION FROM GOVERNMENT/SEMI
GOVERNMENT INSTITUTIONS
WORK EXPERIENCE
WHETHER CENTRAL/STATE GOVT./PSU'S/GOVT. AUTONOMOUS BODIES/UNIVERSITY'S OR PRIVATE :

SL.NO. NAME OF DESIGNATION ADDRESS START END NATURE RESONE


EMPLOYER OF DATE DATE OF OF
EMPLOYER DUTIES LEAVING

1 LA KITCHEN AT-KAITHA 01-01- 05-10- FOOD LEAVE


MERRITAL ASSISTANT PO- 2021 2022 SUPPLY
HOTEL RAMGARH
RAMGARH PS-
RAMGARH
DISTRICT-
RAMGARH

2 LA KITCHEN AT-KAITHA 10-10- 03-11- FOOD LEAVE


MERRITAL ASSISTANT PO- 2022 2023 SUPPLY
HOTEL RAMGARH
RAMGARH PS-
RAMGARH
DISTRICT-
RAMGARH

TOTAL EXPERIENCE AS ON 23RD NOV 2023 2 YEAR(S) 10 MONTH(S) 1DAY(S)

PAYMENT DETAILS
PAYMENT MODE DATE ORDER NO AMOUNT

EXEMPTED

DECLARATION:
I HAVE READ ALL THE PROVISIONS OF NOTICE/ADVERTISEMENT CAREFULLY AND I HEREBY
DECLARE THAT THE INFORMATION SUBMITTED BY ME IS CORRECT AND TRUE TO THE BEST OF MY
KNOWLEDGE. I SHALL BE LIABLE FOR ANY DISCIPLINARY/PUNITIVE ACTION IN CASE ANY OF THE
DETAILS ARE FOUND TO BE INCORRECT. FURTHER I UNDERSTAND THAT MY CANDIDATURE WILL BE
CANCELLED IN CASE OF ANY FALSE MISLEADING INFORMATION IS SUBMITTED BY ME.

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