NATIONAL EDUCATION SOCIETY FOR TRIBAL STUDENTS
Date of Interview
(Write NA, if not applicable)
__/___/2024
PART-I : (BIO DATA)
(TO BE FILLED UP BY THE CANDIDATE & SUBMITTED FOR VERIFICATION OF DOCUMENTS)
POST:_ Junior Secretariat Assistant (JSA)
(Under Recruitment Drive 2023-24) Paste recent passport size
Photograph and put
1. PERSONAL DETAILS: Signature half on the bio
data form and half on the
photograph
i. Name:_________________________________ (in capital le ers)
ii. Father’s Name:__________________________ (in capital le ers)
iii. Roll No:_____________________ Registra on Number_____________________
iv. Date of (Day/Month/Year)
Birth:______________________________
v. Age (as on 31.07.2023): _____Years_____Months_____Days
vi. Category (SC/ST/OBC/UR/EWS): ________________________________
vii. Whether applied under EWS category ________________________________
(Yes/No):
viii. If PwBD, give details of sub category (OH/VI/HI/others)_______________________________
Please specify nature of disability____________________________
ix. Postal Address: ___________________________________
___________________________________
x. Mobile No.: ___________________________________
xi. E-mail address: ___________________________________
2. EDUCATIONAL QUALIFICATION:
S.No. Course of Study Year of Max. Marks Marks %age of
Passing Obtained Marks/CGPA
i. Class Xth ___________________
ii. Class XIIth ___________________
iii. Cer ficate of possessing minimum
speed of 35 words per minutes in Yes / No (Please ck one)
English typing or 30 words per
minute in Hindi
iv. Any Other ________________
(Please enclose proof in respect of conversion of grades into marks)
3. Experience in Government Residen al Schools: (If Any)
S.No. Name of the School Affiliated to Dura on Period
From To From To
4. If serving in EMRS or elsewhere, please submit NOC from employer____________________________
5. Whether knowledge of computer applica on/opera on: Yes / No (Please ck one)
UNDERTAKING
I do hereby declare that no legal and/or criminal case is pending against me before any
court/inves ga ng agencies, I, further inform that I have never been found guilty / convicted of any legal
offence and/or crime by any court of law in the past.
I do understand and agree that in the event if my ineligibility being detected at any stage , prior to
the verifica on or therea er , my candidature .appointment during any stage of service for the post shall
stand forfeited.
(SIGNATURE/THUMB IMPRESSION OF THE CANDIDATE WITH DATE)
PART-II FOR OFFICE USE
A) CHECKLIST
Please check the following, if found OK, make (√) mark in the Box otherwise put (X) mark in the
said box in red ink.
1. Photo It matches with the one given in the applica on and it is also
self a ested.
2. Iden ty It is verified with the original copy (i.e PAN, Driving License,
Voter I Card, Passport, Aadhar Card-any one).
3. D.O.B It is verified with birth Cer ficate issued by the Competent
Municipal Authori es or SSLC/ Std. X Cer ficate with DOB.
4. Category: It is verified with Caste Cer ficate issued by appropriate
(OBC/SC/ST/EWS) authority in prescribed format. The cer ficate is in the
prescribed format applicable for employment in
Government of India.
5. PwBD Verified with the requisite cer ficate.
6. Ex-Serviceman Verified with the requisite cer ficate.
7. Whether Govt. (i) Verified with the requisite cer ficate
Servant
(ii) NOC available
EMRS Regular / (i) Verified with the requisite cer ficate
Contractual
Employee (ii) NOC available
8. Age Does not exceed the maximum age as on cutoff date i.e.
31.07.2023.
Not exceeding 30 years.
Age relaxa on for SC/ST/OBC and other categories as
applicable under the Govt. of India Rules.
Up to 55 years for EMRS employees
9. Qualifica on As per adver sement i.e Direct Recruitment Drive through
ESSE-2023
NOTE:
Please ensure that the candidate fulfills all the criteria i.e Age, Educa onal Qualifica on and
Experience as on the cut-off date i.e cutoff date as per the no fica on for Direct Recruitment drive
through ESSE-2023 which is 31.07.2023.
REASON FOR INELIGIBILITY
1. Being over aged as on cut off date.
2. Not possessing requisite qualifica on as on cut off date.
3. Non -produc on of OBC/SC/ST/PwBD/EWS cer ficate.
4. Any other reasons (to be specified by the Verifying Officer).
CERTFICATE OF VERIFYING OFFICER
Cer fied that I have scru nized personally the informa on in Part-I above with originals and found it
to be in Order / Not in Order. I have also checked the eligibility as per the check list. Candidate is
Eligible / Not Eligible for the post. The reasons for ineligibility is / are:
1.--------------------------------------------------------------
2.-------------------------------------------------------------
3.---------------------------------------------------------------
Signature of the Verifying Officer________________________
Name of the Officer: __________________________________
Designa on:_________________________________________
Place of Pos ng: _____________________________________
Date of Verifica on_________________________________
COUNTER CHECKED BY CONTROLLING OFFICER
Cer fied that I have thoroughly checked the documents and found them in Order / Not in Order. It
is also cer fied that the Candidate if found Eligible / Not-Eligible.
Signature of the Officer______________________________
Name of the Officer:_________________________________
Designa on:_________________________________________
Place of Pos ng: _____________________________________
Date :_________________________________
