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Application Slip

The document is an application form for the position of Laboratory Assistant at the Bihar Staff Selection Commission, submitted by Kiran, a 19-year-old female applicant. It includes personal details, educational qualifications, and payment information, confirming her registration and declaration of truthfulness. Kiran has completed her 10th and 12th grades with notable percentages and has provided her Aadhar card as identification proof.

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rammumar1981
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151 views2 pages

Application Slip

The document is an application form for the position of Laboratory Assistant at the Bihar Staff Selection Commission, submitted by Kiran, a 19-year-old female applicant. It includes personal details, educational qualifications, and payment information, confirming her registration and declaration of truthfulness. Kiran has completed her 10th and 12th grades with notable percentages and has provided her Aadhar card as identification proof.

Uploaded by

rammumar1981
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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BIHAR STAFF SELECTION COMMISSION


P.O.-VETERINARY COLLEGE, PATNA - 800014
ADVERTISEMENT NO. 04/25
LABORATORY ASSISTANT
PERSONAL DETAILS
REGISTRATION NO.: 2540010232
FORM NO. : 3540010232
NAME OF APPLICANT : KIRAN
FATHER'S NAME : RAM KUMAR
MOTHER'S NAME : MAMTA DEVI
GENDER : FEMALE
MOBILE NO. : 8745080356
EMAIL ID : KIRAN550006@GMAIL.COM
DATE OF BIRTH : 09-02-2005 LIVE PHOTO

AGE AS ON 01-08-2024 : 19 YEARS, 5 MONTHS, 23 DAYS


NATIONALITY : INDIAN
CATEGORY : UR
DOMICILE OF BIHAR STATE : NO
ARE YOU PERSON WITH DISABILITY? : NO

PHOTO

SIGNATURE IN ENGLISH

SIGNATURE IN HINDI

DO YOU HAVE AADHAR CARD? : YES (AADHAR CARD NUMBER: 233055989948)


ID PROOF : AADHAAR CARD ID PROOF NO : 233055989948
BIHAR GOVERNMENT EMPLOYEE WHO HAS RENDERED NOT LESS THAN 3 YEARS REGULAR AND
NO
CONTINUOUS SERVICE? :
NUMBER OF ATTEMPTS AFTER BIHAR GOVERNMENT EMPLOYEE? (AFTER DATE: 12-12-2022) : 00
IDENTIFICATION MARK OF THE CANDIDATE : INJURY MARKS ON CHIN
ARE YOU AN EX-SERVICEMAN? : NO
WARD OF FREEDOM FIGHTER? : NO
HAVE YOU EVER BEEN DEBARRED FROM ANY COMPETITIVE EXAMINATION (UPSC/BOARD/STATE
YES
COMMISSION/ANY OTHER)? :
NAME OF BOARD/STATE COMMISSION: JEE MAINS YEAR:2024
HAVE YOU WORKED UNDER BIHAR GOVERNMENT AFTER BEING RELEASED FROM NCC AFTER
JANUARY 1, 1963?:
ADDRESS DETAILS

CORRESPONDENCE ADDRESS PERMANENT ADDRESS

ADDRESS: PRASHANT ENCLAVE BAROLA NAJAFGARH ADDRESS: PRASHANT ENCLAVE BAROLA NAJAFGARH
VILLAGE/MOHALLA: PRASHANT ENCLAVE VILLAGE/MOHALLA: PRASHANT ENCLAVE

POST OFFICE: NAJAFGARH POST OFFICE: NAJAFGARH


POLICE STATION: NAJAFGARH POLICE STATION: NAJAFGARH
DISTRICT: SOUTH WEST DELHI DISTRICT: SOUTH WEST DELHI

STATE: DELHI (NCT) STATE: DELHI (NCT)


PIN CODE: 110043 PIN CODE: 110043
EDUCATIONAL QUALIFICATIONS
EDUCATION SUBJECT BOARD / TOTAL MARKS MARKS OBTAINED PERCENTAGE PASSINGDATE CERTIFICATE
UNIVERSITY NUMBER
ENGLISH HINDI
10TH /
MATHS SCIENCE CBSE 500 422 84.40 22-07-2022 0368196
EQUIVALENT
SST
I.SC./10TH
+2 ENGLISH MATHS
(SCIENCE) CHEMESTRY
CBSE 500 399 79.80 13-05-2024 0182423
I.SC./10TH PHYSICS PHYSICAL
+2 EDUCATION
(SCIENCE)
PAYMENT DETAILS:
PAYMENT BANK : SBI
TRANSACTION ID : 1902820919115
TRANSACTION DATE : 2025-05-19 07:50:51
REGISTRATION FEE (RS.) : 540
DECLARATION DETAILS:

I HEREBY DECLARE THAT THE INFORMATIONS FILLED UP ABOVE BY ME ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I ALSO DECLARE
THAT I HAVE FILLED UP ONLY ONE APPLICATION FORM. I ALSO UNDERTAKE THAT IF ANY INFORMATION IS FOUND OTHERWISE, I SHALL BE LIABLE
FOR ANY LEGAL ACTION AND CANCELLATION OF MY CANDIDATURE.
DATE : 20-05-2025 09:39:45
DECLARATION ACCEPTED : YES

NOTE: PLEASE KEEP YOUR REGISTRATION NO.,PASSWORD,MOBILE NO AND EMAIL-ID CAREFULLY FOR FURTHER REFERENCE.

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