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Staff Selection Commission: Multi Tasking Staff (MTS) Examination 2019

This document is an application for the Multi Tasking Staff (MTS) Examination 2019 that has been provisionally accepted. It provides personal details of the applicant such as name, father's name, date of birth, category, identification marks, educational qualifications, address details, signature, and a declaration accepting the terms and conditions of the notice of examination.

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ANIL
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66 views

Staff Selection Commission: Multi Tasking Staff (MTS) Examination 2019

This document is an application for the Multi Tasking Staff (MTS) Examination 2019 that has been provisionally accepted. It provides personal details of the applicant such as name, father's name, date of birth, category, identification marks, educational qualifications, address details, signature, and a declaration accepting the terms and conditions of the notice of examination.

Uploaded by

ANIL
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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STAFF SELECTION COMMISSION

BLOCK NO. 12, CGO COMPLEX, LODHI ROAD, NEW DELHI


110003

MULTI TASKING STAFF (MTS) EXAMINATION 2019

REGISTRATION NO: 83000143508

APPLICATION IS PROVISIONALLY ACCEPTED


1. NAME AS PER 2. NEW/CHANGED
MATRICULATION 3. FATHER'S NAME 4. MOTHER'S NAME
NAME
CERTIFICATE
ANIL KUMAR PASSI - MOHAN LAL PASSI LILABATI DEVI
5. DATE OF BIRTH (DD/MM/YYYY) 6. AGE AS ON 01/08/2019 7. GENDER
20/09/1993 25.1 MALE
8. CATEGORY 9. ID NUMBER 10. NATIONALITY
SC 90XXXXXXXX01 CITIZEN OF INDIA
11. MARK OF VISIBLE IDENTIFICATION : MARK ON RIGHT SIDE OF EYE
12. MATRICULATION (10th CLASS) EXAMINATION 13. MATRICULATION (10th 14. MATRICULATION (10th
BOARD CLASS) ROLL NO CLASS) YEAR OF PASSING
CENTRAL BOARD OF SECONDARY EDUCATION
5194301 2010
(CBSE)
15. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER ( FIRST ) EXAMINATION CENTER ( SECOND ) EXAMINATION CENTER ( THIRD )

3013 - VARANASI 3003 - ALLAHABAD 3206 - PATNA


16.1. HAVE YOU ALREADY
JOINED A CIVIL POST BY 16.3. DATE OF DISCHARGE
16.WHETHER EX- 16.2. LENGTH OF SERVICE IN
AVAILING BENEFIT OF FROM ARMED FORCES
SERVICEMAN (ESM)? ARMED FORCES ( IN YEARS )
RESERVATION FOR EX- (DD/MM/YYYY)
SERVICEMAN (ESM) :?
NO - - -
17. WHETHER PERSON WITH DISABILITY 17.1 IF YES, TYPE OF DISABILITY (OH, HH,VH, OTHERS)
(PWD) ?
NO -
18.1 WHETHER SUFFERING FROM CEREBRAL PALSY
-
18.2 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)?
-
18.3 WHETHER SCRIBE IS REQUIRED 18.4 WILL YOU MAKE YOUR OWN 18.5 IF SCRIBE IS TO BE
ARRANGEMENT OF SCRIBE? ARRANGED BY SSC, INDICATE
MEDIUM
- - -
19. WHETHER SEEKING AGE RELAXATION? 19.1 IF YES,INDICATE CODE
NO -
20. STATE(S) / U.T. PREFRENCE CODE
M,F,J,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X
21. EDUCATIONAL QUALIFICATION
B. TECH
22. DO YOU BELONG TO ECONOMICALLY WEAKER SECTIONS (EWS) ?
-
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. POSTAL ADDRESS 25. PERMANENT ADDRESS
BAJATI BARAI KA PURA BAJATI BARAI KA PURA
PO KHAKHAICHA PO KHAKHAICHA
DIST ALLAHABAD DIST ALLAHABAD
DISTRICT: ALLAHABAD DISTRICT: ALLAHABAD
STATE: UTTAR PRADESH STATE: UTTAR PRADESH
PIN: 212405 PIN: 212405
MOBILE NO. : 8513912799 EMAIL ID: [email protected]
SIGNATURE

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.
PRINT TAKEN ON: 06/05/2019 10:01:08 PM

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