STAFF SELECTION COMMISSION

BLOCK NO. 12, CGO-COMPLEX, LODHI ROAD, NEW DELHI

110003
CONSTABLE (GD) IN CAPFS, NIA, SSF AND
RIFLEMAN (GD) IN ASSAM RIFLES
EXAMINATION 2018
REGISTRATION NO :72000193248

APPLICATION IS PROVISIONALLY SUBMITTED

1. CANDIDATE'S NAME 2. FATHER'S NAME 3. MOTHER'S NAME
SONU PAHADIYA MANDAN LAL PAHADIYA GEETA DEVI
4. DATE OF BIRTH (DD/MM/YYYY) 5. AGE AS ON DATE (01/08/2018) 6. GENDER
12/03/1998 20.4 FEMALE
9. MARK OF VISIBLE
7. CATEGORY 8. NATIONALITY
IDENTIFICATION
SC CITIZEN OF INDIA CUT MARK ON RIGHT LEG
10. MATRICULATION (10th CLASS) 12. MATRICULATION (10th
11. MATRICULATION (10th CLASS) ROLL NO
EXAMINATION BOARD CLASS) YEAR OF PASSING
BOARD OF SECONDARY EDUCATION,
1703395 2016
RAJASTHAN
13. PREFERENCE OF EXAMINATION CENTER
PREFERENCE OF EXAMINATION CENTER CODE PREFERENCE OF EXAMINATION CENTER
2405 JAIPUR
2401 AJMER
2402 ALWAR
14.WHETHER EX- 14.1. IF EXS, WHETHER 14.2. LENGTH OF SERVICE ( 14.3. DATE OF DISCHARGE
SERVICEMAN (ExS)? ELIGIBLE FOR IN YEARS )
RESERVATION?
NO - - -
15. WHETHER SEEKING AGE 15.1. IF YES,INDICATE CODE 16. STATE / UT OF DOMICILE 17. DISTRICT OF
RELAXATION? DOMICILE
NO RAJASTHAN JAIPUR
18. HAVE YOU MIGRATED FROM THE 18.1 IF YES,WHETEHR YOU WOULD 18.2 IF NO,WHETHER YOU WANT TO
STATE/ UT OF YOUR ORIGIN TO THE LIKE TO AVAIL RESERVATION FROM BE CONSIDERED AS A UR
STATE/ UT WHERE YOUR CASTE IS THE STATE/ UT OF ORIGIN CANDIDATE FROM THE STATE/ UT
NOT RECOGNISED AS SC/ ST/ OBC? OF DOMICILE
NO - -
18.3. STATE OF ORIGIN 18.4. DISTRICT OF ORIGIN 19. CANDIDATE BELONGS 20. CANDIDATE BELONGS
TO MILITANCY/ NAXAL TO BORDER DISTRICT
AFFECTED DISTRICT
- - NO NO

21. PREFERENCE OF POSTS FOR CAPF'S & ORGANISATIONS

BCADEFGH
22. DO YOU WANT TO MAKE AVAILABLE YOUR PERSONAL INFORMATION FOR ACCESSING JOB OPPORTUNITY IN
TERMS OF DoP&T'S O.M NO.39020/1/2016-ESTT.(B) DATED 21.06.2016 ?
NO
23. EDUCATIONAL QUALIFICATION
BA

ADDRESS DETAIL
24. POSTAL ADDRESS 25. PERMANENT ADDRESS
90 GOVIND NAGAR RAMPURA ROAD SANGANER 90 GOVIND NAGAR RAMPURA ROAD SANGANER

DISTRICT: JAIPUR DISTRICT:JAIPUR

STATE: RAJASTHAN STATE: RAJASTHAN
PINCODE: 302029 PINCODE: 302029
MOBILE NO: 9782642564 EMAIL: 2019sonu19982019@gmail.com
SIGNATURE THUMB IMPRESSION

FEE AMOUNT TRANSACTION NO TRANSACTION DATE

EXEMPTED - - -
DECLARATION
I HEREBY DECLARE THAT ALL 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 OR AFTER THE EXAMINATION, MY CANDIDATURE/ APPOINTMENT IS LIABLE TO BE
CANCELLED.I AM WILLING TO SERVE ANYWHERE IN INDIA.
PRINT TAKEN ON: 21/08/2018 6:36:46 PM