Registration ID :
Haryana Staff Selection
Commission 1094241
1. Applicant's Name: MANISH KUMAR
2. Father's Name: JARNAIL SINGH
3. Mother's Name: SAKUNTLA DEVI
4. Gender: MALE
5. Date of Birth: 04/10/2001
6. Marital Status: UNMARRIED
7. Nationality: INDIAN
8. Visible Indentity Mark on body: BLACK SPOT ON RIGHT EYEBROW
9. If any FIR is lodged/Pending NO
against the applicant?:
10. Address & Contact Details: HOUSE NO.- 00/ STREET NO.- 0/
LAND MARK- VPO INDACHHOI/
PINCODE- 125120, INDACHHOI,
TOHANA BL, FATEHABAD, HARYANA,
125120
11. Mobile No : 8198909637
12. Email Id : vermamktt@gmail.com
Reservation Details
13. Category: BC (A)
14. Benchmark Disability : NO
15. EWS : NO
16. Ex-Serviceman : NO
17. Interested Job Category : GROUP C & D
18. Eligible Sports Person (ESP): NO
19. Are you domicile of Haryana State: YES
20. Is DESM (Ex-Servicemen Dependent)?: NO
21. Did you passed/studying Hindi/Sanskrit in class 10th or YES
above?:
22. Payment Detail: FEE PAID ON 31/01/2022
23. Would you be availing the benefit of reservation policy of YES
Goverment of Haryana in recruitment to Group C and Group D
posts?:
Qualifying Examination Details
Education Board / University Result Roll No. Marksheet Grading Mark Total Percentage
Type No. System Obtained Marks
Class10th Haryana Board of Pass 2017545339 AS Non 313 500 62
School Education 176365 CGPA
Class12th Haryana Board of Pass 3019251274 AT021988 Non 437 500 87
School Education CGPA
Socio Economic Criteria
1. Any person from among the applicant's father, mother, NO
spouse, brother and son is/ was or has been a regular
employee in any department/ Board/ Corporation/ Company/
Statutory Body/ Commission/ Authority of Government of
Haryana or any other state Government or Government of
India:
2. Is Applicant a Widow? : NO
3. Is father of candidate is deceased? : NO
4. If the applicant belongs to such a denotified tribe(Vimukt NO
Jatis and Tapriwas Jatis) or Nomadic tribe of Haryana which is
nether a Scheduled Caste nor a Backward Class. :
5. Age relaxation due to experience: NO
Experience Details
Declaration by Candidate
1. I have not sent any other application for this recruitment. I know if I violate this rule. My application will be
cancelled by the Staff Selection Commission.
2. I have carefully read all the conditions given in the release and hereby I am eligible for this post and
abide by them I promise to.
3. I also declare that I fulfils all the condition related age limits, educational qualifications and finds which
are prescribed for this recruitment.
4. For Ex-Servicemen, I announce that I fulfils all the conditions of Ex-Serviceman related eligibility as per
advertisement.
5. I also declare that till date I have not been prevented from appearing in any examination / experiential
course by any agency / selection committee of the State of Haryana and have not been convicted by any
legal court.
6. For the candidates belonging to the Other Backward Classes, I declare that I belong to the community
which has been considered as a backward class for the purpose of reservation in services by the State
Government, as per the State Government orders. It is also announced that the State Government, by the
various amendments mentioned in the notice are not related to the mentioned individuals / categories. I also
declare that I have a certificate of OBC.
7. I also declare that I have applied only in one reserved category prescribed by the Government of
Haryana.
8. I hereby declare that all the details given in this application form are true, complete and correct as per my
maximum information and belief. I understand / understand that my candidature / appointment can be
cancelled if any information is found to be hidden / false or untrue or if ineligibility is detected.
Place : TOHANA
Date : 31/01/2022
Candidate Signature : ------------
