STAFF SELECTION COMMISSION
BLOCK NO. 12, CGO-COMPLEX, LODHI ROAD, NEW DELHI
110003
COMBINED GRADUATE LEVEL EXAMINATION, 2020
REGISTRATION NO: 10003112706
APPLICATION IS INCOMPLETE
1. NAME AS PER 2. NEW/ CHANGED 3. FATHER'S NAME 4. MOTHER'S NAME
MATRICULATION CERTIFICATE NAME
DAMA MANOJKUMAR - DAMA SUBRAMANYAM DAMA INDIRAMMA
6. AGE AS ON
5. DATE OF BIRTH (DD/MM/YYYY) 7. GENDER 8. CATEGORY
01/01/2021
01/07/1998 22.6 MALE EWS
9. WHETHER PERSON WITH DISABILITY (PWD) ? 9.1 IF YES, TYPE OF DISABILITY (OH, HH,VH, OTHERS)
NO -
10. NATIONALITY 11. MARK OF VISIBLE IDENTIFICATION
CITIZEN OF INDIA A MOLE ON RIGHT LEG
12. MATRICULATION (10th CLASS) EXAMINATION 13. MATRICULATION (10th 14. MATRICULATION (10th
BOARD CLASS) ROLL NO CLASS) YEAR OF PASSING
BOARD OF SECONDARY EDUCATION ANDHRA
1319112111 2013
PRADESH
15. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER
(FIRST PRFERENCE ) (SECOND PREFERENCE ) (THIRD PREFERENCE )
DELHI ( 2201 ) JAIPUR ( 2405 ) HARIDWAR ( 2005 )
16.2. LENGTH OF SERVICE 16.3. DATE OF DISCHARGE FROM ARMED FORCES
16.1. WHETHER EX-
IN THE ARMED FORCES (IN (DD/MM/YYYY)
SERVICEMAN (ESM) ?
YEARS)
NO - -
16.4. HAVE YOU ALREADY JOINED A CIVIL POST BY
AVAILING BENEFIT OF RESERVATION FOR EX- 16.5. DATE OF JOINING THE CIVIL POST (DD/MM/YYYY)
SERVICEMAN (ESM) ?
- -
17. 1. WHETHER SUFFERING FROM CEREBRAL-PALSY ?
-
17.2. 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) ?
-
17.3. WHETHER SCRIBE IS REQUIRED ? 17.4. WILL YOU MAKE YOUR OWN 17.5. IF SCRIBE IS TO BE ARRANGED
ARRANGEMENT OF SCRIBE ? BY SSC, INDICATE MEDIUM
- - -
18. ARE YOU ALSO APPLYING FOR THE POST OF JUNIOR 19. DO YOU POSSESS EQ FOR THE POST OF JUNIOR
STATISTICAL OFFICER (MoSPI)? STATISTICAL OFFICER (MoSPI)?
NO -
20. WHETHER SEEKING AGE RELAXATION ? 20.1 IF YES, AGE RELAXATION CODE
NO -
21. HIGHEST EDUCATIONAL QUALIFICATION
B. TECH (14)
22. DETAILS OF QUALIFYING EDUCATIONAL QUALIFICATION
GRADUATION
STATE/ UT OF
PASSING NAME OF
STATUS BOARD/ ROLL NO PERCENTAGE CGPA
YEAR BOARD/ UNIVERSITY
UNIVERSITY
PASSED 2019 ANDHRA PRADESH OTHERS R131490 - 7.6
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 ?
YES
ADDRESS DETAIL
24. CORRESPONDENCE ADDRESS 25. PERMANENT ADDRESS
KANCHANAPUTTURU B N KANDRIGA CHITTOOR 517640 KANCHANAPUTTURU B N KANDRIGA CHITTOOR 517640
DISTRICT: CHITTOOR DISTRICT:CHITTOOR
STATE: ANDHRA PRADESH STATE: ANDHRA PRADESH
PIN : 517640 PIN : 517640
MOBILE NO: 7989265835 EMAIL:
[email protected] 27. DATE ON WHICH THE UPLOADED PHOTOGRAPH 28. WHETHER THE DATE OF PHOTOGRAPH IS CLEARLY
HAS BEEN TAKEN PRINTED ON THE PHOTOGRAPH
(DD/MM/YYYY):
03/12/2020 YES
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
NOT EXEMPTED 100 - -
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: 24/01/2021 12:10:17 PM IP ADDRESS:47.30.193.235
