Application Form Application Number Token Number 1. Exam Details 1.1 Examination 1.2 Post 1.

3 District Head Quarter for 1.4 General Subjects (PRE) 1.5 Optional Subjects (PRE) 1.6 General Subjects (MAINS) 1.7 Optional Subjects (MAINS) 1.8 Number Of Attempts 2. Department Preferences 2.1 Department Preference 3. Applicant's Details : 3.1 Applicant's Full Name 3.2 Applicant's Father Full Name : 3.3 Applicant's Mother Maiden Name : 3.4 Date Of Birth (dd/mm/yyyy) : 3.5 Gender : 3.6 Marital Status : : 3.7 Category : 3.8 Home State (Bonafide 3.9 Home District : arpita saxena alok kumar johari indu saxena 13/11/1990 FEMALE Unmarried General/OBC( Creamy Layer ) RAJASTHAN JAIPUR Photo & Signature Of Candidate 4. Other Special Categories 4.1 Category for Disabled 4.2 Specific Category for Female 4.3 Other Category 5. Correspondence Details 5.1 Address : : : : 1 - WATER RESOURCE DEPT , 2 - PHED , 3 - PANCHAYATI RAJ DEPT : 001110101857906 : 1300011100000278 : : : : ASSISTANT ENGINEER CIVIL EXAM 2013 ASSISTANT ENGINEER CIVIL JAIPUR Gen Science ,GK with Ref. to Rajasthan Application Filled Date Reference Application : 10/03/2013 11:24 AM : 001110101857906

: CIVIL ENGINEERING : HINDI | SOCIAL ASPECTS OF ENGINEERING : CIVIL ENGINEERING : 0

: infront of bsnl office,station road, sambhar lake,Tehsil : PHULERA,City/Village : sambhar lake - 303604 Dist : JAIPUR, State : RAJASTHAN

5.2 Email 5.3 Phone 5.4 Mobile 6. Qualification

: saxenaarpita41@gmail.com : 01425224534 : 9468589074

Year Division/Grade

6.1 Secondary : 2004 6.2 Sr. Secondary : 2006 6.3 Graduation : 2011 6.4 Post Graduation : 2013 7. Additional Qualifications/Specifications 7.1 Other 7.2 Examination passed 7.3 Internship Period 7.4 Experience 8. Identification 8.1 Body Mark : : : From : : Year :

I II I

Passed Appearing

To : Months : Days :

: mole on right eye

9. Disclaimer I hereby declare that all information made in this application are true, complete and correct to the best of my knowledge and belief. In the event of my information being found false or incorrect or the ineligibility being detected before or after the Screening Test/Interview, action can be taken against me by the Commission. I have read the provisions of the relevant rules and the Advertisement carefully and I hereby undertake to abide by them. I further declare that I fulfill all the conditions of eligibility regarding age limits, educational qualification and required experience etc. prescribed for admission to the Screening Test/Interview. Also I accept SMS facility provided by the Commission.

Rajasthan Public Service Commission Ghooghara Ghati, Jaipur Road, Ajmer Phone : +91+145+ 5151200, 5151240 & 5151090

Nodal Officer: Mr. Akhilesh Mittal,System Analyst(0145-5151212)