8/28/2017 Application Form

PPSC-4

PUNJAB PUBLIC SERVICE COMMISSION

Application Number:

54505611
1.Post Applied For: EDUCATOR-(SPECIAL EDUCATION DEPARTMENT)

2.Advertisement Number: 44/2017

3.Case Number: 28C2017

4.Bank Receipt Date: 28-08-2017

5.Amount: Rs 600/-

6.Bank Name/Receipt Number: NBP /138

6(i) Branch Name: PEOPLES COLONY , FAISALABAD

7.Candidate's Name: AQSA KHAN
8.Father's Name: NASRULLAH KHAN
9.Postal Address: STREET # 09, BLOCK HIMMAT PURA, JARNWALA ROAD
10.Gender: FEMALE 11.CNIC NO: 3310284012454 11(i).CNIC Expiry Date: 17-03-2026
12.Religion: MUSLIM 13.Marital Status: SINGLE 13(i). Spouse Name:
14.DOB: 09-10-1991 15.Age ( on Closing Date): 25 Year(s) 10 Month(s) - 19 Day(s)

16.Phone No: 3008096855 17.Mobile Number: 03056539370 18.E-mail: libra786khan@gmail.com

19.Domicile: FAISALABAD 19(i).Domicile Issue Date: 09-09-2013
20.Do you Claim to be a Disabled Person? NO
a. If Yes, then Type of Disability: NO
b. If Blind, then Examination Mode: NO
c. Disable Certificate Ref. No. NA
d. Disable Certificate Issue Date: NA
21. Government Employee? NO
a. If Yes, then Type of Service NA
b. Date of Joining NA
c. Length of Service NA
d. Obtained NOC From Employer? NO
22. Retired / Released Armed Forces Person? NO
a. If Yes, then Length of Service 0 Year (s) 0 Month (s) 0 Day (s)
b. Convicted by Court Martial? NO
23.Ever Dismissed from Government / Autonomous body ? NO
a. If Yes, Produce Original Certified Documents from Concerned
Departments at the Time of Interview , if Called for
24. Do you Claim Additional Marks as an Unemployed Child of a Punjab
24(i). Father / Mother CNIC
Unemployed Child of a Punjab Government Servant who was Incapacitated or NO 0
No:
Died while in Service?
25(i). If Yes, Produce Detail at the Time of Interview, if
25. Ever been Convicted by a Court in Pakistan? NO
Called for

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8/28/2017 Application Form
26. Are you Facing any Criminal Trial in any Court of NO 26(i) If Yes, Produce Detail at the Time of Interview, if
Pakistan? Called for
27.PMDC / PNC / OEC / 27(i). Registration 28. Medical Certificate
PCATP / PBC NO : Expiry Date: Issue Date:
29. Written Test / Examination / Interview Centre: FAISALABAD 30. No. of Chances Availed for this Post: 0
31. Physical Standard (For Uniform Posts Only):
Height
Chest Normal Expanded
Vision Distant Vision Left: Distant Vision Right: Near Vision Left: Near Vision Right:
32. Academic Qualifications:

RESULT
BOARD / EXAMINATION OBTAINED TOTAL %AGE /
CERTIFICATE/DEGREE SUBJECTS DECLARED
UNIVERSITY SYSTEM MARKS MARKS GRADE
ON
BIOLOGY,
B.I.S.E
MATRICULATION PHYSICS, 01/08/2008 ANNUAL 582 850 68.47
FAISALABAD
CHEM
B.I.S.E
INTERMEDIATE COMMERCE 04/09/2010 ANNUAL 715 1100 65.00
FAISALABAD
PUNJAB
BACHELOR COMMERCE 06/06/2013 ANNUAL 818 1500 54.53
UNIVERSITY
ALLAMA IQBAL
B.ED. OPEN ARTS 16/01/2015 ANNUAL 614 900 68.22
UNIVERSITY

33. Service Record (if required)

POST HELD DEPARTMENT / OFFICE STARTING DATE ENDING DATE SCALE

DISCLAIMER: I certify that all information in the Application Form submitted by me is correct and in case any information is
found to be incorrect, it will disqualify my candidature. I also certify that I have read all requirements / conditions of this post
along with the General Instructions in this regard.

Date: 28-08-2017 Candidate's Signature: --------------------------------------------

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