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This online application is provisional subject to payment of application fees/ intimation charges

Registration # : 10012842

Full Name :


One Time ID : Name of The Post Applying for : Are you a Destitute Widow? : Are you a Differently Abled Person? : Are you an Ex-Serviceman ? : PPO No : Date of Discharge / Probable Discharge / Date : Are you a Government Employee? : Nationality / Citizenship : Application Fee / Intimation Charges details: Payment Mode: Amount : Personal Details : Date of Birth : Gender : Married : Religion : Candidate's Place of Birth : Native District : Father's Name : Father's Place of Birth : Mother Tongue : Mother's Name : Spouse's Name : Communal Category : Name of the SubCaste : Certificate No : Date Of Issue : Issuing Authority : Taluk : District : Address for Correspondence :

-Group IV,Group VIII Executive Officer GR-IV NO NO NO --NO Indian

Indian Bank 150.00

07/08/1988 FEMALE No Hindu Andaman and Nicobar Coimbatore k Kannusamy Sivaganga Tamil k Amudha -Most Backward Class(MBC) Andipandram 4337899 13/02/2009 Deputy Tahsildar Thiruppur Coimbatore 3,Naren Garden P.S.G Layout (Back Side) Kalapatti Post

District State : Pin : Permanent Address :

Coimbatore Tamil Nadu 641048 3,Naren Garden P.S.G Layout (Back Side)

Kalapatti Post District State : Pin : Contact Details : Email ID : Mobile No : EDUCATIONAL QUALIFICATION PARTICULARS : Exam Passed S.S.L.C : Others : Details regarding the prescribed qualification : Qualification Details : Other Equivalent Qualification Details : Certificate No : Year of Passing : Name of the Authority/ University : Preferential qualification for per notification : SSLC -232301 2004 cbse No English Type writing / Short hand Qualification Type Writing Short hand Name of the Examination Centre District: Name of the Examination Centre : Compulsory Subject (apart from General Knowledge) : Do you claim Age Concession? : Do You Claim Fee Exemption? : Post Preference : Criminal Case (Registered/Pending/Punishment awarded) : Participation in Political Activities (In agitation/As a Member of Political Organisation/Candidature in Election) : Post Qualification work experience (Start from present Employer) : Name of the Organisation Previous appearance for Oral Test / Written Test Name of the Post Register No. Year Designation From(mm/yyyy) To(mm/yyyy) Nature of Duty Coimbatore Coimbatore North General Knowledge with Tamil No No -Not Applicable Not Applicable --Tamil --Year of Passing 2004 Medium of Instruction English -Whether studied Tamil as one of the subject Yes 9994782117 Coimbatore Tamil Nadu 641048




1. I hereby declare that all the particulars furnished in this application are true, correct and complete to the best of my knowledge and belief. In the event of any information being found false or incorrect or ineligibility being detected before or after the examination, action can be taken against me by the TNPSC. 2. I hereby declare that I will not be a party to any kind of canvassing on my behalf.

3. I further declare that I fulfil all the eligibility conditions prescribed for admission to the examination.

4. I have informed my employer in writing that I am applying for this Examination.

5. I have gone through the Instructions etc. to candidates and the Commissions notification for this Recruitment before filling up the application form.

6. I declare that I possess the medical standards prescribed for the post(s) which I am now applying.

7. I certify that I have not been debarred by the TNPSC or any other recruiting agency.

8. I am not a dismissed Government Employee.

I accept the above declaration


Date: 2012-04-30 11:00:13

Signature of Applicant

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