Print Application Form

(UTTAR PRADESH PUBLIC SERVICE

COMMISSION, PRAYAGRAJ)
उ र दे श लोक सेवा आयोग, यागराज
Detailed Application Form ( व तृत आवेदन प )

✔ I declare that I have Read the detailed User Manual and Notification.

Notification Details ( Examination )

Advertisement Number : A-5/E-1/2019  

Examination Name : Assistant Engineer (General/Special

Recruitment) Examination- 2019,

Apply for Examination : Assistant Engineer (General/Special

Recruitment) Examination- 2019,

Type of Recruitment : GENERAL-SPECIAL RECTT. BOTH

Candidate's Personal Details

Registration 90300530824 Application ID : 200003903001503

No. :

Candidate's ABHINAV Father's/Husband's LALMAN AMBEDKAR

Name : PRAKASH Name :

Gender : Male Date of Birth : 04/07/1992

Domicile of Yes Category : SC

UP :

Are you No
Married?

Mobile XXX-XXX-5826 Email-ID : ****nav.prakash.09@gmail.com

Number :

Bank Transaction Details

Payment State Bank Of India Payment Mode INB

Gateway : :

Fee Amount : Rs. 105.00 Transaction ID - CPX7308893  -

Date: 09/01/2020

Candidate's Other Details :

 Are you Dependent of UP Freedom Fighter? No Are You Skilled Player No
Of UP? :

Are you UP Ex. Army? No Service Duration (Day- 0  -  

Month-Year) : 0  -   
0

    Retirement ___
Date(Date/Month/Year)
:

Are you ECO/SSCO/CO of Army ? No Have you complete 5 No

year service ?

Have your services been extended for rehabilitation and no disciplinary action is No
pending against you ?

Are You Handicap of UP? No a. Are you Blind Or Have Vision

problem? : No

b. Are you Deaf or Have hearing problem? : No c. Have you any physical
Problem? : No

Are You State Govt. Employee of Uttar Have you ever been Debarred from UPPSC
Pradesh ? :   No ?:   No
       

Are you an employee of Mandi Parishad / No

Mandi Samiti who has been separated from Service Duration (Year-Month-Day) : 0  - 0  - 
service and who is covered by the order of 0
Hon'ble Supreme Court dated 16.12.2005 in
Civil Appeal No 4092/2001 State of U.P.
Petitioner vs. Neeraj Awasthi and Others ?

Have you already rendered one year's No

service or more in any of the Centralised Duration of Service (Year-Month-Day) : 0 - 0
Services or in the Nagar Nigam /Palika /Jal -0
Sansthan /Jal KAl Vibhag/Vikas
Pradhikaran ? :

Do you want six year age relaxation in upper No

age for who was entitled in respect of his
age to appear at a selection in any year, in
which no selection is made(2013-2019),
shall be deemed to be entitled in respect of
his age to apper at the next following
selection ?;
Do you want one year age relaxation in No
upper age for the post Assistant Engineer
(Civil) of Medical deptt., Assistant Engineer
(Civil, Mechanical) of Irrigation deptt. and
Assistant Engineer (Civil) the upper age limit
in the case of a candidate, who is trainee,
shall be greater by one year. ?

High School & Intermediate Board,Year of passing & Roll Number Details :

Sr.No Examination Board Name Year of Passing Roll Number

Passed

1. High School UTTAR PRADESH BOARD OF HIGH 2005 1471323

SCHOOL AND INTERMEDIATE
EDUCATION

2. Intermediate UTTAR PRADESH BOARD OF HIGH 2007 0869934

SCHOOL AND INTERMEDIATE
EDUCATION
Essential Qualification Details

Sr Qualification Affirmation
No.

1 Till last date for submitting the applications, the candidates must possess Yes
Degree in any one of the following Branch awarded by an Institution or
University established by law in India.- (1) Civil Engineering. OR (2) Mechanical
Engineering. OR (3) Agriculture Engineering OR (4) Electrical Engineering OR (5)
Chemical Engineering OR (6) Industrial Engineering.

Have you a Diploma/Degree in Yes

Engineering :

Your Opted Engineering Branch Name :

05 - Electrical Engineering ( व ुत अ भयं ण )

Preferential Qualification Details

Sr.No. Qualification Acquired

1 A candidate who has (1) served in the Territorial Army for a minimum period No
of two years, or (2) obtained a "B" certificate of N.C.C. shall other things being
equal, be given preference in the matter of direct recruitment.

Candidate's Address Details :

C/O- Name : LALMAN AMBEDKAR House No. : R. K. 175

Street No./PO : KALINDIPURAM City Name : ALLAHABAD

State : UTTAR PRADESH District Name : PRAYAGRAJ

PIN : 211015    
 I accept the following declaration : : Yes

1. I hereby declare that I have read all terms & conditions according to the
advertisement and I accept it.

2. I hereby declare that all the entries/statements made in this application are
true, complete and correct to the best of my knowledge and belief.

3. I under take that if any information furnished or documents submitted by me

are found to be false or have been concealed, then my application/candidature
is liable to be rejected/cancelled by UPPSC.

Current status of Application Form :

Your application is under processing.

Application Form Submission Date :   Application Form printing Date & Time : [ 10/01/2020
09/01/2020 , Time : 16:51:53   ,12:19:09 ]            
Application Modification Date & Time :
10/01/2020 12:18:00