GOVERNMENT OF ASSAM
COMBINED APPLICATION FORM FOR FILLING UP POSTS UNDER
DIRECTORATE OF MEDICAL EDUCATION, DIRECTORATE OF HEALTH SERVICES, DIRECTORATE OF HEALTH SERVICES (F/W) ASSAM
Personal Details:
Application No. : 2410080113
Full Name of the Candidate RUPA SARKAR
:
( As per Aadhaar Card/ Pan Card/ Passport )
Candidate's Father's Name : SEBOK SARKAR
Candidate's Mother's Name : NIOTI SARKAR
Candidate's Spouse Name :
Candidate's Date of Birth (DD/MM/YYYY) : 08/01/2001
Gender : FEMALE
Correspondence Address : GOSSAIGAON, W/NO: 4
: MAHARAJPUR
: TINALI
City : GOSSAIGAON
District : KOKRAJHAR
State : ASSAM
Pin Code : 783360
Permanent Address : GOSSAIGAON, W/NO: 4
: MAHARAJPUR
: TINALI
City : GOSSAIGAON
District : KOKRAJHAR
State : ASSAM
Pin Code : 783360
Mobile No. of the Candidate : 8811808881
Alternative Contact No. Telephone / Mobile : 9954849208
E-mail Address of the Candidate : [email protected]
Nationality of the Candidate : INDIAN
Physical identification Marks :
Category of the Candidate : SC
Do you belong to Physically challenged/Divyang?) : NO
Whether Candidate is Permanent Resident of Assam ? : YES
Employment Exchange Registration No. of Assam : : 4176747/12/2021
Do you want to apply for Non - Technical Posts : YES
(Group-5) - Health Educator, (Group-10) - Library Assistant, Assistant Librarian, (Group-8) -
Account Assistant, Clerk cum Record Keeper, Clerk cum Record Keeper cum Computer Operator,
GRADE - III Non Technical Posts : Coding Clerk, Coding Clerk Record Keeper, Computer Operator, Documentalist, Junior Assistant,
LDA Cum Computer Operator, LDA/Computer Operator cum Clerk, (Group-7) - Health Educator
Cum Sanitary Inspector,
Marks Marks Percentage Year of
Exam Passed Stream Name of School / Board / College / University
Obtained Out Of Of Marks Passing
HSLC Or Equivalent (10) : 360 600 60 % 31/05/2016 SEBA
HSSLC Or Equivalent (10+2) : ARTS 285 500 57 % 31/05/2018 AHSEC
Graduation : ARTS 1340 1700 78.82 % 07/12/2021 Gauhati University
Diploma Non Technical : 1 YEAR DIPLOMA/CERTIFICATE IN COMPUTER APPLICATION 670 1000 67 % 30/03/2023 Techinaut, Institute of technology
Do you have appropriate
computer certification YES
as per advertisment.
Employment Exchange Registration No. YES
Employment Exchange Registration No. 4176747/12/2021
Date: 15/01/2025 16:25:13 Signature of Applicant
