Application Form

Panchayti Raj Department, Govt. of Bihar

Application for Recruitment
Application Details
Application ID :     TAT/0008143 Application Date : 01-Sep-2018 Post Applied For : Technical Assistant
Personal Details
Applicant Name : ABHIJIT KUMAR
Father's /Husband's Name : ANJANI SHARMA
Date of Birth : 11-Oct-1995
Age on (01.08.2018) : 22 Years 9 Months
Gender : Male
Category : GEN
Nationality : Indian
Email ID : abhijitsharma841@gmail.com
Mobile No. : XXXXXXX7495
Aadhar Type Aadhar No
Aadhar No XXXXXXXX4210
Phone With STD Code : 7992307495
Physically Handicapped No
Grand Children of Freedom Fighter No

Address for Correspondence

Address : house no 97
ward no 6 kalyanpur samastipur
Pin Code : 848302

Permanent Address
Address : house no 97 ward no 6 kalyanpur samastipur
Pin Code : 848302
State of Domicile : Bihar
Home District : SAMASTIPUR
Choice District : SAMASTIPUR

Educational Qualification
  Board/University Specialization State Whether Passing Marks Full Marks Marks
Government or Year Obtained (Excluding Obtained
Private (Excluding Extra  (%)
Extra Subject)
Subject)
I.Matric BSEB Bihar Government 2011 294 500 58.8
II.Intermediate/12th BSEB Science Bihar Government 2013 307 500 61.4
IV.Diploma KIIT Diploma in Civil Orissa Private 2017 636 1000 63.6
UNIVERSITY Engineering
V.Additional 0 0 0 0
Qualification

I declare that all the above information is correct to the best of my knowledge and that I shall be liable for punishment if
any information is found incorrect. I also declare that I have understood the guideline for engagement and will fully abide
by the same including any future guideline issued by Panchayti Raj Department in this regard.

Place:-

Date:-
Signature of Applicant