Application for the Position of District Facilitators

1. Name of the candidate (In Block letters) : RAVI SHANKAR MISRHA

2. Father/ Husbands name (In block letters) : SHRI SANJAY KUMAR MISHRA
3. Date of Birth : 21/11/1986
4. Nationality : INDIAN
5. Present Address with pin code : SANJAY COMMUNICATION, AMAHIYA MAIN ROAD,
for correspondence REWA (M.P.) - 486001
6. Permanent Address : SANJAY COMMUNICATION, AMAHIYA MAIN ROAD,
Ph. No. : REWA (M.P.) - 486001
Mobile No. : 9303498099
E-mail id : ravi.mishra1512@gmail.com
7. Educational Qualifications (Higher Secondary and above) (Please attach Xerox Copies) :

Sr. Name of the Year of Name of the % of Div./ Subjects taken

No. Examination Passing Board/ Marks Class
passed University

1 12th 2005 CBSE 55.8 2nd MATHEMATICS

BARKATULLAH COMPUTER
2 BCA 2008 UNIVERSITY 61.42 1st APPLICATIONS

3 MBA 2011 APSU 67.47 1st MARKETING AND HR

8. Details of Employment (Please mention relevant Work Experience)

Sr. Office /Post Held From/To Nature of Duties

No (Work Duration)

SANJAY
COMMUNICATION TRAINING, WEBSITE AND
1 /MANAGER (IT) APRIL 2008 TO JUNE 2009 SOFTWARE DEVELOPMENT
INSTITUTE OF
SCIENCE AND
PROMPT HANDLE RURAL DEVELOPMENT,
COMPUTER LITERACY, HEALTH AWARNESS,
SYSTEM/ SANITATION AND SKILL
PROJECT DEVELOPMENT PROGRAMMES
2 COORDINATOR JUNE 2011 TO NOV 2012 AT DISTRICT AND BLOCK LEVEL
DEPT OF
ECONOMICS AND GOVT PROJECT TRAININGS AND
STATISTICS SEMINARS, STATISTICAL
(GOVT. OF ANALYSIS, SURVEY, STASTICAL
MADHYA BOOK PUBLICATION, TEHSIL
PRADESH) LEVEL OFFICER (ECONOMICS
3 /ENUMERATOR DEC 2012 TO MARCH 2015 CENSUS 2012)
 LABOUR BUREAU
(MINISTRY OF SURVEY, DATA COLLECTION,
LABOUR AND STATISTACAL ANALYSIS,
EMPLOYMENT) TRAINING, PRESENTATIONS
4 /INVESTIGATOR MAY 2015 APRIL 2017 AND SEMINARS

9. Name of contract details of 3 referees :

S.no Name Designation Complete address with mobile number & email
ICICI PRUDENTAIL LIFE INSURANCE
AJEET COMPANY LTD. 9009660010
1 SINGH MANAGER ajeet.parihar85@gmail.com
PRAFULL BLOCK PHE DEPARTMENT SATNA 9981058280
2 TIWARI COORDINATOR tiwariprafull@gmail.com
AMBIKESH LABOUR BUREAU (GOVT OF INDIA)
PRASAD 9009550228
3 PANDEY INVESTIGATOR pandeyambikesh22@gmail.com

In case the candidate is shortlisted reference checks will be made.

10.. Preference for District : REWA

Declaration

I do hereby declare that all the statements made in the application are true to the best of my
knowledge and belief. In the event of any information being found false at any stage, my candidature is
liable to be rejected.

Place: REWA Signature of the candidate

Date: 30/04/2017