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    Application Form Draft Print For All

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    studyking408

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    © All Rights Reserved
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    Application Form Draft Print For All

    Uploaded by

    studyking408
    8 views3 pages

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    ApplicationFormDraftPrintForAll (1) (1)

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    Copyright:

    © All Rights Reserved
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    8 views3 pages

    Application Form Draft Print For All

    Uploaded by

    studyking408

    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: 50005524521

    APPLICATION RECEIVED (CONTENTS NOT VERIFIED)

    1. NAME AS PER MATRICULATION 2. NEW/CHANGED


    3. FATHER'S NAME 4. MOTHER'S NAME
    CERTIFICATE NAME
    ANKIT VISHWAKARMA - RAJENDRA VISHWAKARMA ANNU VISHWAKARMA
    5. DATE OF BIRTH (DD/MM/YYYY) 6. AGE AS ON 01/01/2024 7. GENDER 8. CATEGORY
    01/07/2000 23.6 MALE OBC
    9. NATIONALITY 10. MARK OF VISIBLE IDENTIFICATION
    CITIZEN OF INDIA NO MARKS
    12. MATRICULATION (10th 13. MATRICULATION (10th
    11. MATRICULATION (10th CLASS) EXAMINATION BOARD
    CLASS) ROLL NO CLASS) YEAR OF PASSING
    MADHYA PRADESH BOARD OF SECONDARY EDUCATION 173425942 2017
    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)

    SAGAR ( 6015 ) JABALPUR ( 6007 ) BHOPAL ( 6001 )

    18. MEDIUM FOR COMPUTER BASED 19. STATE/ UT OF DOMICILE 20. DISTRICT OF DOMICILE
    EXAMINATION (CBE)
    HINDI MADHYA PRADESH UMARIA
    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)
    C,A,B,D,E,F,H,
    25. HIGHEST EDUCATIONAL QUALIFICATION
    INTERMEDIATE/ HIGHER SECONDARY/ 10+2 (2)
    26. DETAILS OF QUALIFYING EDUCATION
    10TH STANDARD
    STATUS PASSING STATE/ UT OF BOARD/ NAME OF BOARD/ ROLL NO PERCENTAGE CGPA
    YEAR UNIVERSITY UNIVERSITY
    PASSED 2017 MADHYA PRADESH MADHYA PRADESH 173425942 76.33 -
    BOARD 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 ?
    YES
    ADDRESS DETAIL
    28. CORRESPONDENCE ADDRESS 29. PERMANENT ADDRESS
    GRAM MAJHGAWA CHANDIYA UMARIYA GRAM MAJHGAWA CHANDIYA UMARIYA
    DISTRICT: UMARIA DISTRICT: UMARIA
    STATE: MADHYA PRADESH STATE: MADHYA PRADESH
    PIN: 484660 PIN: 484660
    MOBILE NO. : 6267464720 EMAIL ID: ankitvish6540@gmail.com
    30. WHETHER PHOTOGRAPH HAS BEEN TAKEN ON OR AFTER 24-AUGUST-2023?
    YES
    FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE

    NOT EXEMPTED 100 CPADHHRII1 28/11/2023


    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: 28/11/2023 7:22:30 PM IP ADDRESS: 152.58.58.116

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