5/18/2017 TeachersRecruitmentBoard

ApplicationNo. 157749

Candidate'sName SELUMALAI

DateofBirth 30/05/1980

Age(Ason1st July,2017) 37years,1months,and2days

Gender Male

Community MBC/DNC

Father'sName SUBRAMANIK
Mother'sName INTHIRANIS
Areyoudifferentlyabled? No
EmailID keerthivasanki@gmail.com
MobileNo. 8124920745

NameOfExam Board/University MediumOfInstruction Month&YearOfPassing

SSLC StateBoard Tamil 101996

HSC StateBoard Tamil 032000

UG UNIVERSITYOFMADRAS English 062003

PG THIRUVALLUVARUNIVERSITY English 082006

B.Ed. THIRUVALLUVARUNIVERSITY Tamil 082007

Haveyoudoneanyoftheprescribedqualifications(UG/PG/B.Ed.)asan
No
integratedcourse?
Postappliedfor History
SubjectstudiedinUGDegree/IntegratedPGDegree History
SubjectstudiedinPGDegree/IntegratedPGDegree History
Doyouhavehighersecondaryclassteachingexperienceinthepost
appliedfor,aftercompletingalltherequiredqualificationsforthepostofPG No
Assistant?
HaveyouregisteredinProfessional&ExecutiveEmploymentExchange
Yes
aftercompletingalltherequiredqualificationsforthepostofPGAssistant?
DateofRegistrationinProfessional&ExecutiveEmploymentExchange
22/08/2007
aftercompletingalltherequiredqualificationsforthepostofPGAssistant.
ChoiceofExamDistrict Thiruvannamalai
AddressforCommunication
aAddress1 816
bAddress2 METTUSATHIRAM
cAddress3 INAMKARIYANDAL
District TIRUVANNAMALAI
State TamilNadu
PinCode 606604
FeePaymentDetails

a.TransactionNumber212319666 b.DateofTransaction2017051717:25:54 c.Amount500.00(ConvenienceCharges&ServiceTaxasapplicable)

Declaration
1.Ihavegonethroughtheinstructionstothecandidatesandtheboard'snotificationforthisrecruitmentbeforefillinguptheapplicationform.
2.Iherebydeclarethatalltheparticularsfurnishedinthisapplicationaretrue,correctandcompletetothebestofmyknowledgeandbelief.
3.Iamawarethatintheeventofanyinformationbeingfoundfalseorincorrectatanystageormyineligibilitybeingdetectedatanytime,TRBisatlibertytodisqualifymycandidatureat
anystageandalsocancelmyselection,ifmade.
4.IherebydeclarethatIwillnotbeapartytoanykindofcanvassingonmybehalf.
5.Iwillproducethenecessarycertificatesordocumentaryproofrelatedtotherecruitmentatthetimeofcertificateverification,ifcalledforanduponselectionorthereafter.
6.Ihaveverifiedthecorrectnessoftheparticularsfurnishedintheapplicationandwilltakeaprintoutoftheapplication.

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