West Bengal Group D Recruitment Board

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WEST BENGAL GROUP D RECRUITMENT BOARD

APPLICATION FORM FOR THE POST OF GROUP D IN WEST BENGAL (2017)

8A86A7A781816E80E280301284BD163E6CF3451501C32FC5486D27D6B6FFDC62

101453097MG900302A
Application
Sl. No. 101453097
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To
The Chairman
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West BengalG900302NAA
Group D Recruitment
Board
Utility Buildings, Action Area IIC,
(Near Mangaldeep
Rotary), New
Town, Kolkata-700161
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Sir,
I hereby apply for the post of GROUP D (2017). Necessary particulars are furnished below:-

Post applied for
: GROUP D (2017)
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Advertisement
No
: WBGDRB Dated
01.01.2017 G900302NAA G900302NAA G900302NAA G900302NAA G900302NAA
Name in FullG900302NAA G900302NAA
: AJIT KUMAR
JENA
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Gender
: Male
Category
: UR
Indian
: Yes
Persons with Disability (PWD)
Date of Birth : 02/03/1990

: Not Applicable

Father's / Husband's Name
: BIPIN BIHARI JENA
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Mother's Name
: PUSPANJALI
JENA
ExService-Men
: No
Service Experience
Details G900302NAA
:
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Month
Days
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00
00
00

Sports Quota - Participated in :
Games/Sports :
Tournament
Mobile
: 9090985484
Email
: ajitkumarjenapmir@gmail.com

Complete Mailing Address
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PLOT NO- 892/1767,LAXMISAGAR,
BHUBANESWAR,ODISHA
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PO : BUDHESWARI
POLICE STATION
: LAXMISAGAR
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DISTRICT : KHORDHA
PIN : G900302NAA
751006
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STATE : ODISHA
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Permanent Address
PLOT NO- 892/1767,LAXMISAGAR,

BHUBANESWAR,ODISHA
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PO : BUDHESWARI

POLICE STATION : LAXMISAGAR

DISTRICT : KHORDHA PIN : 751006

STATE : ODISHA

Educational Qualification
: Class VIII Pass : Yes

Name of Examination
Year of Passing (YYYY)

Name of the School / Board / Council / University
2004
MUNICPAL
SCHOOL, LAXMISAGAR,BHUBANESWAR,ODISHA
Class
VIII
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GRADUATION
2011
UTKAL UNIVERSITY

1 of 2
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Application G900302NAA
Sl. No. 101453097
101453097MG900302B
Name : AJITG900302NAA
KUMAR JENA G900302NAA G900302NAA G900302NAA
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Do you belong to exempted category?
: NO
Opted Language Paper
: HINDI
Religion
: HINDUISM
Registration & NCO No. issued by the
department, Govt.
of W.B. :
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Declaration :

(i) I possess all the Essential Qualifications for the Post.
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(ii) I solemnly
declare that G900302NAA
all statements made
in this application
form areG900302NAA
true, complete G900302NAA
and correct to the
best of my knowledge
and belief. In the event of any information being found suppressed / false or incorrect, or if my ineligibility is detected before,
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during or
after the testsG900302NAA
and medical examination,
my candidature
/ appointment
will stand
cancelled andG900302NAA
my claim to recruitment
will stand forfeited. I also declare that I have submitted no other application form for this examination.

Place : BHUBANESWAR
Yours faithfully,

Date : 21 JanG900302NAA
2017 10:06:27 G900302NAA G900302NAA G900302NAA G900302NAA G900302NAA G900302NAA G900302NAA
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Full signature of the candidate

2 of 2
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West Bengal Group D Recruitment Board

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West Bengal Group D Recruitment Board

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