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ON-LINE APPLICATION FOR RECRUITMENT OF CLERICAL CADRE

3503

Registration # : 3000068945

Full Name : MANOJ KUMAR

State/UT Applied for : Jharkhand

Category : SC

If Person with Disability : NO

Type of Disability : -

Percentage of Disability : -

Do you intend to use the services of a scribe (only for VI & OH candidates whose writing

speed is affected by cerebral palsy) ? :NA

Are you candidate who had o rdinarily been domiciled in Kashmir Division of the State

of J & K during the period 1-1-1980 to 31-12-1989 ? :

NO

Whether you belong to Religious Minority Community ? : NO

Religion to which you belong : -

Are you an Ex-Serviceman ? : NO

Are you Disabled Ex-Serviceman (DXS) ? : NO

Are you a Matriculate ? :

Have you obtained the Indian Army Special Certificate of Education

or corresponding certificate in the Navy or the Air Force, after having

completed not less than 15 years of service in Armed Forces of the Union :

Are you Dependent of an Ex-Serviceman killed in action ? : NO

Are you seeking relaxation under widow /divorced women / women

judicially Separated from their husbands and who are not re-married ? :NO

Nationality / Citizenship : INDIAN

Centre of Examination : Ranchi

Centre Code : 76

Application Fee / Intimation Charges details:

Payment Mode: ONLINE

Amount : 50.00

Personal Details :

Date of Birth : 30-09-1988

Age completed as on 01.12.2011 : 23

Gender : MALE

Husband's Name/Father's Name : AWADHESH RAM

Mother's Name : MANOBRITI DEVI

Address for Correspondence : S/O-AWADHESH RAM

QR NO-375 TYPE-2

RAJRAPPA PROJECT

District RAMGARH

State : JHARKHAND

Pin : 829150

Permanent Address : VILL-BASDIHA GOPAL

THANA-KUTUMBA

PO-HARIHARGANJ

District AURANGABADH

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State : BIHAR

Pin : 824119

Contact Details :

Email ID : manojkrbit07@gmail.com

Phone No : -

Mobile No : 9955318626

Qualification Details (as on 01.12.2011):

Exam Passed Subject /Stream Date of Passing % of Marks

SSC/Equivalent : ENG MATH SCI SST SAN 28-05-2004 75.40

HSC/ 12th(10+2) / Equivalent :ENG BIO PHY CHEM

PHE23-05-2006 64.20

Graduation/Equivalent : BBA 30-06-2010 81.70

Other Details :

Would You l ike to undergo Pre-Exam Training (SC/ST/Minority Community/ XS /

DXS / Dependents of XS) :YES

If Yes Centre for Training : Ranchi

Languages Known Read Write Speak

English YES YES YES

HINDI YES YES YES

DECLARATION:

I hereby dec lare 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 untrue or incorrec t at any stage or my not satisfying any of the eligibility cr iteria according to the Central Rec ruitment & Promotion Department, my candidature is liable to cancelled. I

am willing to serve anywhere in India including rural areas.

Place:

Date: 05-01-2012 Signature of Applican

Please retain your Registration No. and Password emailed to you carefully for further reference

NOTE: Please DO NOT SEND application printout to CRPD/ SBI

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