son2016 sscorlinenicinjecegistationpprietvectypet jsp Government of India STAFF SELECTION COMMISSION e 2 “Application Registration No: 62003686140 for the Junior Enginner Civil/Mechanical/Electrical/Electronics and Quantity Surveying & Contract) Examination - 2016 ‘Your Application is Completed [L.&2, Name of Computer Based written Examination Center and Code : [NR-Dethi(2201) INR-Jeipur(2405) INR-Dehradun(2002) (3.Candidate Name : [PUNEET SHARMA i4.Father's Name : DEVENDRA SHARMA ‘5.Mother's Name 'ANIU SHARMA (6.Date of Birth (ddimmm/yyyy) = [2910971988 7.Gender (Male 8. Nationality Indian \9.Fee Exemption claimed : Fee Paid 10.Category = General 10.1. Whether Ex-Serviceman? : INo 110.2. For Ex-Serviceman-Length of Service(in years) 10.2. Date of discharge (dd/mmiyyyy) = |L1, Whether PE (PWD): No ILA. I yes, indicate code : 12, Whether seeking Age relaxation? + INo 12.1. Ifyes, indicate code 12.2. Age(as on 01.08.2016} 27.10 13.Subject for General Engineering , Paper-I & Paper IT: (civil |14, Whether you belong to Religious Minority Community ? = INo 115. Medium for paper-IT [English 116. Preference for posts : (CFAIKE 117. Aadhar Card Number (Ifavailable): [307610440921 |18.Mark of Visible Identification : (CUT MARK UNDER CHIN 19, Education Qualification [Subject [M.TECH (Civil Engineering BE (Civil Bogineoring Diploma (Civil Engineering 19.1. Do you want to make available your personal Information for the accessing job opportuni (B) dated 21.06.2016 ? in terms of DoP & T's O.M.No. 39020/1/2016-Estt. ‘Yes 120. Details of Work Experience/Govt. Service renderei Name of the Organisation(s) [Designation [Nature [Period OF lor Iservice [Duty (des)] From(mm/yyyy)] ToCmm/yyyy) I21.Postal Address : IMIG - 66 SWARNA JAYANTI NAGAR RAMGHAT ROAD ADA COLONY ALIGARH Vgc IALIGARIT District: ALIGARH Sine: iar Pst Fincode: 20201 22.Permanent Ades: Bai 6@ SWARNA JAVANTI NAGAR RAMGHAT Sine: iar Pras hip sscontna ric injeragistraionpatiniverfyrntjsp 42sscorlinenicinjecegistatonpaprietvectypet jsp [202001 [8439706506 puncet2177@gmail.com 23.Photo 24.Signature (MS [Payment Details = {Transaction id IKO00EDMG4 [Transaction Date(yyyy-mim-dd) (2016-10-12 [Payment Mode lonline ‘Amount 1100 [Declaration Place: ‘Date (yyyy-mm-dd):2016-10-12 Thereby declare that all the 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 and after examination, my candidature/appointment is liable to be cancelled. Signature of Candidate ip sscontinaric injeragistraionpatinivertyrintjsp Print Application Form Go to SSC Online Application Home Page