Sie sind auf Seite 1von 2

1 of 2

http://164.100.129.99/mts/pdfprint/verifyprint.jsp

Application Registration No: 64000346890 for the Multi Tasking(Non - Technical) Staff In Different States/ UTs, 2016
Your Application is not Completed
WR-Surat(7007)
1.& 1.1. Name of Center and Center Code :
WR-Vadodare(7002)
WR-Ahmedabad(7001)
PALAK JATINKUMAR ARIWALA
JATINKUMAR K ARIWALA
VARSHABEN

2.Candidate Name :
3.Father's Name :
4.Mother's Name :
5.Date of Birth (dd/mm/yyyy) :

17/09/1993
23.10
Indian

6. Age(as on 01.08.2017) :
7. Nationality :
8.Gender :
9.Category :
10. Whether PH (PWD) :
10. If yes, indicate code :
10.1. Whether Ex-Serviceman? :
10.2. For Ex-Serviceman-Length of Service(in years) :
10.2. Date of discharge (dd/mm/yyyy) :
11. Whether seeking Age relaxation? :
11.1. If yes, indicate code :
12. Whether suffering from cerebral palsy? :
12. If VH/Cerebal Palsy candidate, whether scribe is required ?
13. if yes indicate medium :
14. Whether you belong to Religious Minority Community ? :
15. Aadhar Card Number (If available):
16.Mark of Visible Identification :
17. State/UT Code :
18. Educational Qualification :
19. Details of Work Experience :
Name of the organisation

Male
General
No
No

No

No
649584931776
1GUJRATXXXXXXXXXXXXXXXXXXXXXXXXXX
Graduate

Designation

Nature of Duty(ies)

Period of
Period of
Service
Service
From(mm/yyyy) To(mm/yyyy)

24-KRUSHNAKUNJ SOCIETY CHHAPRABHATHA


ROAD - AMROLI
AMROLI
SURAT

20.Postal Address :
Village/City :
District :
State :
Pincode :
21.Permanent/Domicile Address :
State :

Gujarat
394107
24-KRUSHNAKUNJ SOCIETY CHHAPRABHATHA
ROAD- AMROLI OPP. SWAMI NARAYAN TEMPLE
-AMROLI - SURAT
Gujarat

Pincode :
STD Code :
Phone Number :

394107

Mobile Number :
Email ID :

9173341950
ariwalapalak@gmail.com
23.Signature

22.Photo

05-01-2017 16:42

2 of 2

http://164.100.129.99/mts/pdfprint/verifyprint.jsp

Payment Details :
Transaction id :
Transaction Date(yyyy-mm-dd) :
Amount :
Declaration

I hereby declare that all the 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 and after examination, my candidature/appointment is liable to be cancelled.
Place:
Date (yyyy-mm-dd):
Signature of Candidate

Go to SSC Online Application Home Page

05-01-2017 16:42

Das könnte Ihnen auch gefallen