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SSC CHSL Exam 2018 Application Details

Rajeev from Himachal Pradesh has applied for the Combined Higher Secondary Level Examination 2018 conducted by Staff Selection Commission. He is a 19 year old male from the scheduled caste category with no disabilities. He has studied in Himachal Pradesh Board of School Education and passed 10th class in 2015. His preferred examination centers are Hamirpur, Shimla and Chandigarh. He is not an ex-serviceman and does not require any age relaxation or scribe assistance. His permanent address is listed as Village Gouta, Tehsil and District Hamirpur, Himachal Pradesh. He has declared that all information provided in this application is true.

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Sahil
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45 views2 pages

SSC CHSL Exam 2018 Application Details

Rajeev from Himachal Pradesh has applied for the Combined Higher Secondary Level Examination 2018 conducted by Staff Selection Commission. He is a 19 year old male from the scheduled caste category with no disabilities. He has studied in Himachal Pradesh Board of School Education and passed 10th class in 2015. His preferred examination centers are Hamirpur, Shimla and Chandigarh. He is not an ex-serviceman and does not require any age relaxation or scribe assistance. His permanent address is listed as Village Gouta, Tehsil and District Hamirpur, Himachal Pradesh. He has declared that all information provided in this application is true.

Uploaded by

Sahil
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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STAFF SELECTION COMMISSION

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


110003

COMBINED HIGHER SECONDARY (10+2) LEVEL


EXAMINATION 2018

REGISTRATION NO: 74000763265

APPLICATION IS PROVISIONALLY ACCEPTED


1. NAME AS PER
2. NEW/CHANGED
MATRICULATION 3. FATHER'S NAME 4. MOTHER'S NAME
NAME
CERTIFICATE
RAJEEV - NAND LAL SAVITRI DEVI
5. DATE OF BIRTH (DD/MM/YYYY) 6. AGE AS ON 01/08/2019 7. GENDER
15/05/2000 19.2 MALE
9.1 .IF YES, TYPE OF
9. WHETHER PERSON WITH
8. CATEGORY DISABILITY (OH, HH,VH,
DISABILITY (PWD) ?
OTHERS)
SC NO -
10. NATIONALITY 11. MARK OF VISIBLE IDENTIFICATION
CITIZEN OF INDIA BLACK MOLE ON FACE
12. MATRICULATION (10th CLASS) EXAMINATION 13. MATRICULATION (10th 14. MATRICULATION (10th
BOARD CLASS) ROLL NO CLASS) YEAR OF PASSING
HIMACHAL PRADESH BOARD OF SCHOOL
150208966 2015
EDUCATION
15. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER ( FIRST ) EXAMINATION CENTER ( SECOND ) EXAMINATION CENTER ( THIRD )
HAMIRPUR (1202) SHIMLA (1203) CHANDIGARH (1601)
17. WHETHER 12th STANDARD PASS IN SCIENCE STREAM WITH
16. MEDIUM OF TYPE TEST MATHEMATICS AS A SUBJECT FROM A RECOGNIZED BOARD OR
EQUIVALENT (FOR C&AG AS DATA ENTRY OPERATOR)
ENGLISH NO
18.1. HAVE YOU ALREADY
JOINED A CIVIL POST BY 18.3. DATE OF DISCHARGE
18.WHETHER EX- 18.2. LENGTH OF SERVICE IN
AVAILING BENEFIT OF FROM ARMED FORCES
SERVICEMAN (ESM)? ARMED FORCES ( IN YEARS )
RESERVATION FOR EX- (DD/MM/YYYY)
SERVICEMAN (ESM) :?
NO - - -
19.1 DO YOU SUFFER FROM CEREBRAL-PALSY:
-
19.2 DO YOU HAVE A PHYSICAL LIMITATION TO WRITE AND SCRIBE IS REQUIRED TO WRITE ON YOUR BEHALF
(CERTIFICATE TO THIS EFFECT FROM THE CHIEF MEDICAL OFFICER/ CIVIL SURGEON & MEDICAL
SUPERINTENDENT OF A GOVERNMENT HEALTH CARE INSTITUTION AS PER NOTICE OF THE EXAMINATION
WOULD BE REQUIRED AT THE TIME OF EXAMINATION)?
NO
19.5 IF SCRIBE IS TO BE
19.4 WILL YOU MAKE YOUR OWN
19.3 WHETHER SCRIBE IS REQUIRED ARRANGED BY SSC, INDICATE
ARRANGEMENT OF SCRIBE?
MEDIUM
NO - -
20. WHETHER SEEKING AGE RELAXATION? 20.1 IF YES,INDICATE CODE
NO -
21. EDUCATIONAL QUALIFICATION
INTERMEDIATE/ HIGHER SECONDARY/ 10+2

22. DO YOU BELONG TO ECONOMICALLY WEAKER SECTIONS (EWS) ?

-
23. 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

ADDRESS DETAIL
24. POSTAL ADDRESS 25. PERMANENT ADDRESS
VILL GOUTA VILL GOUTA
PO UKHLI PO UKHLI
TEH AND DISTT HAMIRPUR TEH AND DISTT HAMIRPUR
DISTRICT: HAMIRPUR DISTRICT: HAMIRPUR
STATE: HIMACHAL PRADESH STATE: HIMACHAL PRADESH
PIN: 176042 PIN: 176042
MOBILE NO : 8219797543 EMAIL ID : rajeevgouta2000@gmail.com
SIGNATURE

FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE


EXEMPTED - - -
DECLARATION
1. I HAVE READ THE NOTICE OF THE EXAMINATION AND ACCEPT ALL THE TERMS & CONDITIONS OF
THE NOTICE OF THE EXAMINATION.

2. 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: 30/03/2019 1:55:55 PM

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