28/10/2016 ssconline.nic.in/jeregistration/pdfprint/verifyprint.

jsp

ApplicationRegistrationNo:62004182920fortheJuniorEnginner(Civil/Mechanical/Electrical/ElectronicsandQuantity
Surveying&Contract)Examination2016
YourApplicationisCompleted
1.&2.NameofComputerBasedwrittenExaminationCenterandCode: WRMumbai(7204)
WRNagpur(7205)
WRAhmedabad(7001)
3.CandidateName: ANKITLONARE
4.Father'sName: ASHOKLONARE
5.Mother'sName: NALINILONARE
6.DateofBirth(dd/mm/yyyy): 19/05/1990
7.Gender: Male
8.Nationality: Indian
9.FeeExemptionclaimed: ExemptionClaimed
10.Category: SC
10.1.WhetherExServiceman?: No
10.2.ForExServicemanLengthofService(inyears):
10.2.Dateofdischarge(dd/mm/yyyy):
11.WhetherPH(PWD): No
11.1.Ifyes,indicatecode:
12.WhetherseekingAgerelaxation?: Yes
12.1.Ifyes,indicatecode: 01SC/ST
12.2.Age(ason01.08.2016): 26.2
13.SubjectforGeneralEngineering,PaperI&PaperII: Mechanical
14.WhetheryoubelongtoReligiousMinorityCommunity?: No
15.MediumforpaperII: English
16.Preferenceforposts: LMNBGFHADECIJK
17.AadharCardNumber(Ifavailable): 781931474352
18.MarkofVisibleIdentification: MOLEONLEFTEYE
19.EducationQualification Subject
B.TECH MechanicalEngineering(Production)
M.TECH Others
THERMALENGINEERING

19.1.DoyouwanttomakeavailableyourpersonalInformationforthe
accessingjobopportunityintermsofDoP&T'sO.M.No.39020/1/2016Estt. Yes
(B)dated21.06.2016?:
20.DetailsofWorkExperience/Govt.Servicerendered:
Nature PeriodOf PeriodOf
NameoftheOrganisation(s) Designation of Service Service
Duty(ies) From(mm/yyyy) To(mm/yyyy)
BLOCKNO05QTRB17KAILASHNAGARWCL
21.PostalAddress:
COLONY
Village/City: SAKARAPOSTWANITAH
District: YAVATMAL
State: Maharashtra
Pincode: 445307
BLOCKNO05QTRB17KAILASHNAGAR
22.PermanentAddress: WCLCOLONYSAKARAPOSTWANITAHDIST
YAVATMAL
State: Maharashtra
Pincode: 445307
STDCode:
PhoneNumber:
MobileNumber: 9970663860

http://ssconline.nic.in/jeregistration/pdfprint/verifyprint.jsp 1/2
28/10/2016 ssconline.nic.in/jeregistration/pdfprint/verifyprint.jsp
EmailID: ankit.lonare@gmail.com
23.Photo 24.Signature

Declaration
Iherebydeclarethatallthestatementsmadeinthisapplicationaretrue,completeandcorrecttothebestofmyknowledge
andbelief.Iunderstandthatintheeventofanyinformationbeingfoundsuppressedfalseorincorrectorineligibilitybeing
detectedbeforeandafterexamination,mycandidature/appointmentisliabletobecancelled.
Place:
Date(yyyymmdd):20161028
SignatureofCandidate

PrintApplicationForm

GotoSSCOnlineApplicationHomePage

http://ssconline.nic.in/jeregistration/pdfprint/verifyprint.jsp 2/2