Government of India

Staff Selection Commission

Print Form
STAFF SELECTION COMMISSION
BLOCK NO. 12, CGO COMPLEX, LODHI ROAD, NEW DELHI
110003

Multi-Tasking (Non-Technical) Staff, and Havaldar (CBIC & CBN) Examination, 2024
REGISTRATION NO: 10000962236

Application Completed(Contents Not Verified)

1. CANDIDATE'S NAME (AS PER THE

2. NEW/ CHANGED NAME 3. GENDER 4. CATEGORY
MATRICULATION CERTIFICATE)
SUMIT SINGH - Male EWS

7. DATE OF BIRTH (DD/MM/YYYY)

5. FATHER'S NAME 6. MOTHER'S NAME
(AS PER THE MATRICULATION CERTIFICATE)

SHIV SINGH REKHA DEVI 05/04/2004

8. AGE AS ON 01/08/2024 9. NATIONALITY 10. VISIBLE IDENTIFICATION MARK

20 Years 3 Months 28 Days Citizen of India NO

11. WHETHER A PERSON WITH BENCHMARK DISABILITY (PwBD) ? 11.1. IFYES, TYPE OF DISABILITY (OH, HH, VH, OTHERS)
No -

12. MATRICULATION (10th CLASS) EXAMINATION BOARD 13. MATRICULATION (10th CLASS) YEAR OF PASSING 14. MATRICULATION (10th CLASS) ROLL NO.

Uttarakhand Board of School Education 2019 19065811

ADDRESS DETAILS
15.1 CORRESPONDENCE ADDRESS 16.1 PERMANENTADDRESS
GADKHARK MALLA GADKHARK MALLA

15.2. STATE: Uttarakhand 16.2. STATE: Uttarakhand

15.3. DISTRICT: Pauri Garhwal 16.3. DISTRICT: Pauri Garhwal

15.4. PIN: 246275 16.4. PIN: 246275

17. EMAIL sr5380615@gmail.com 18. MOBILE NUMBER 8126725409

19. HIGHEST EDUCATIONAL QUALIFICATION

Graduation
20. DETAILS OF QUALIFYING EDUCATIONAL QUALIFICATION

20.1. EQ STATUS 20.2. PASSING YEAR 20.3. STATE/ UT of BOARD

Passed 2019 Uttarakhand

20.4. NAME OF BOARD

UTTARAKHAND BOARD OF SCHOOL EDUCATION

20.5. ROLL NUMBER 20.6. PERCENTAGE 20.7. CGPA

19065811 74.2

21. WHETHER YOU ARE AN EX-SERVICEMAN (ESM) OR SERVING IN THE ARMED FORCES? 21.1 DATE OF JOINING THE ARMED FORCES (DD/MM/YYYY)

No -

21.2. DATE OF DISCHARGE FROM ARMED FORCES (DD/MM/YYYY)? 21.3. LENGTH OF SERVICE IN ARMED FORCES

- -

21.4. HAVE YOU ALREADY JOINED A CIVIL POST BYAVAILING BENEFIT OF RESERVATION FOR EX-
21.5. DATE OF JOINING TO CIVIL POST (DD/MM/YYYY)
SERVICEMAN (ESM) ?

No -

22. WHETHER SEEKING AGE RELAXATION ? 22.1. IFYES, AGE RELAXATION CODE

No

23. DO YOU WANT TO MAKE YOUR PERSONAL INFORMATION AVAILABLE FOR ACCESSING JOB OPPORTUNITIES IN TERMS OF DOP&T'S OM NO.39020/1/2016-ESTT.(P) DATED 21/06/2016?

Yes

24. PREFERENCE OF EXAMINATION CENTER

24.1. EXAMINATION CENTER (FIRST PREFERENCE ) 24.2. EXAMINATION CENTER (SECOND PREFERENCE ) 24.3. EXAMINATION CENTER (THIRD PREFERENCE )

NR-Delhi (2201) NR-Dehradun (2002) NR-Haldwani (2003)

25. MEDIUM FOR COMPUTER BASED EXAMINATION (CBE):

English (02)

26.1. ARE YOU A PERSON WITH BENCHMARK DISABILITIES (40% OR MORE) IN THE CATEGORY OF BLINDNESS (VH)?

No
26.2. ARE YOU A PERSON WITH BENCHMARK DISABILITIES (40% OR MORE) IN THE CATEGORY OF BOTH ARMS AFFECTED (BA) OR CEREBRAL PALCY (CP)?

No

26.3. DO YOU HAVE PHYSICAL LIMITATION TO WRITE AS PER PARA 7.2 OR 7.3 OF THE NOTICE?
(CERTIFICATE TO THIS EFFECT FROM COMPETENTATHORITYAS PER FORMATATANNEXURE-1/ANNEXURE-1ATO THE NOTICE OF EXAMINATION, WOULD BE REQUIRED AT THE TIME OF EXAMINATION)?
 No

26.4. WHETHER SCRIBE IS REQUIRED?

No

26.5. WILLYOU MAKE YOUR ARRANGEMENT OF SCRIBE?

No

26.6. IF SCRIBE IS TO BE ARRANGED BY SSC, THEN INDICATE MEDIUM?

-
27. Preference of State(s)/ UT(s)/ CCA(s):

22,14,33,15,20,13,52,51,30,29,25,21,12,40,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE

NOT EXEMPTED 100 2406e5a63ef94215cc 02/08/2024

 DECLARATION
1. I HAVE READ THE NOTICE OF EXAMINATION AND ACCEPTALL THE TERMS & CONDITIONS MENTIONED THEREIN.

2. I HEREBY DECLARE THATALL 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.
3. I AGREE TO AUTHORIZE SSC TO USE MYAADHAR DATA FOR VERIFICATION PURPOSE.

PRINT TAKEN ON: 27-09-2024 4:41 PM

NUMBER OF ATTEMPT(s): 1

(Signature)

IP ADDRESS: 2409:4085:8382:e84a:6445:8c1a:4de4:d765

Print Go Back

Staff Selection
Commission

Public Disclosure of Scores and Other Details of Non-Recommended Willing

Candidates

Useful links

Archives
Disclaimer
Sitemap
Help
Website Policies
Web Information Manager

Contact Us
Block No-12, CGO Complex, Lodhi Road New Delhi

© 2024 SSC. All Rights Reserved

Total Visitor Count: 163324699

Last updated on Sep 26, 2024