STAFF SELECTION COMMISSION
BLOCK NO. 12, CGO-COMPLEX, LODHI ROAD, NEW DELHI
110003
JUNIOR ENGINEER (CIVIL, MECHANICAL,
ELECTRICAL AND QUANTITY SURVEYING &
CONTRACTS) EXAMINATION, 2023
REGISTRATION NO: 50007370625
APPLICATION RECEIVED (CONTENTS NOT VERIFIED)
1. NAME AS PER MATRICULATION 2. NEW/ CHANGED
3. FATHER'S NAME 4. MOTHER'S NAME
CERTIFICATE NAME
DESAI NIKITA PRAKASH - DESAI PRAKASH HINDURAO DESAI VARSHA PRAKASH
6. AGE AS ON
5. DATE OF BIRTH (DD/MM/YYYY) 7. GENDER 8. CATEGORY
01/08/2023
25/02/2002 21.5 FEMALE UNRESERVED
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 BORN MARK ON BACK BLACK SPOT
13. MATRICULATION (10th 14. MATRICULATION (10th
12. MATRICULATION (10th CLASS) EXAMINATION BOARD
CLASS) ROLL NO CLASS) YEAR OF PASSING
MAHARASHTRA STATE BOARD OF SECONDARY AND
F008994 2017
HIGHER SECONDARY EDUCATION
15. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER
(FIRST PREFERENCE) (SECOND PREFERENCE) (THIRD PREFERENCE)
KOLHAPUR ( 7203 ) PUNE ( 7208 ) MUMBAI ( 7204 )
16.1. WHETHER YOU ARE AN EX- 16.2. DATE OF JOINING THE ARMED 16.3. DATE OF DISCHARGE/ LIKELY DATE OF
SERVICEMAN (ESM) OR SERVING FORCES (DD/MM/YYYY) DISCHARGE FROM ARMED FORCES (DD/MM/
IN THE ARMED FORCES? YYYY)
NO - -
16.5. HAVE YOU ALREADY JOINED A
16.4. LENGTH OF SERVICE IN THE CIVIL POST BY AVAILING BENEFIT 16.6. DATE OF JOINING TO CIVIL POST
ARMED FORCES OF RESERVATION FOR EX- (DD/MM/YYYY)
SERVICEMAN (ESM) ?
- - -
17. WHETHER SUFFERING FROM CEREBRAL PALSY ?
-
17. 1 ARE YOU A PERSON WITH BENCHMARK DISABILITIES (40% OR MORE) IN THE CATEGORY OF BLINDNESS (VH)?
17.2 ARE YOU A PERSON WITH BENCHMARK DISABILITIES (40% OR MORE) IN THE CATEGORY OF OHBOTH ARMS AFFECTED
(OH-BA) OR OI-I- CEREBRAL PALSY (OH-CP)?
17.3 DO YOU HAVE A PHYSICAL LIMITATION TO WRITE AS PER PARA 9.2 OR 9.3 OF THE NOTICE (CERTIFICATE TO THIS EFFECT
FROM COMPETENT AUTHORITY AS PER FORMAT AT ANNEXURE-I/ ANNEXURE-IA TO THE NOTICE OF EXAMINATION, WOULD
BE REQUIRED AT THE TIME OF EXAMINATION.)?
17.4 WHETHER SCRIBE IS REQUIRED ? 17.5 WILL YOU MAKE YOUR OWN 17.6 IF SCRIBE IS TO BE ARRANGED BY
ARRANGEMENT OF SCRIBE ? SSC, INDICATE MEDIUM
- - -
18.1. WHETHER SEEKING AGE RELAXATION ? 18.2. IF YES, AGE RELAXATION CODE
NO -
19. POST(S) APPLYING FOR
JE- ELECTRICAL ENGINEERING
20. QUALIFICATION DETAILS
EXP(MIN. 2
QUALIFYING DIPLOMA/ DEGREE SUBJECT/ STREAM
YEARS)
DIPLOMA IN 3 YEARS(51) ELECTRICAL ENGINEERING 0
STATE/ UT OF
PASSING NAME OF BOARD/ PERCENTA
STATUS BOARD/ ROLL NO CGPA
YEAR UNIVERSITY GE
UNIVERSITY
SHIVAJI
PASSED 2023 MAHARASHTRA 2058006 - 8.81
UNIVERSITY
20.1 HIGHEST EDUCATIONAL QUALIFICATION
B.TECH
21. 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
22. CORRESPONDENCE ADDRESS 23. PERMANENT ADDRESS
8A KALPATARU COLONY BEHIND THORAT HOSPITAL 8A KALPATARU COLONY BEHIND THORAT HOSPITAL
NEAR BANK OF MAHARASHTRA KARVE NAKA BRANCH NEAR BANK OF MAHARASHTRA KARVE NAKA BRANCH
GOLESHWAR KAR GOLESHWAR KAR
DISTRICT: SATARA DISTRICT:SATARA
STATE: MAHARASHTRA STATE: MAHARASHTRA
PIN : 415124 PIN : 415124
MOBILE NO: 8432259797 EMAIL: [email protected]
24. CONTACT FOR OTHER NATIONALS
25. WHETHER THE PHOTOGRAPH HAS BEEN TAKEN ON OR AFTER 27-APR-2023?
YES
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.
3. I DECLARE THAT THE PHOTOGRAPH UPLOADED IN THE APPLICATION FORM HAS BEEN TAKEN ON OR
AFTER THE STIPULATED DATED.
4.I AGREE TO AUTHORIZE SSC TO USE MY AADHAAR DATA FOR VERIFICATION PURPOSE.
PRINT TAKEN ON: 16/08/2023 10:23:09 AM IP ADDRESS:103.180.47.88
NUMBER OF ATTEMPT: 1
