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    Note: Please Download The Antecedent Verification Form and Submit 2 Copie's of The Same Duly Signed by You at The Time of Verification

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    ChowdaihPujala
    1. The document is an antecedent verification form that collects personal and background information from a candidate named Pujala Chowdaiah who has applied for a post under Category II Group B. 2. It requests information about the candidate's identity, family, education history, residential history, criminal history, and responsible persons who can verify the candidate's identity and background. 3. The candidate is asked to declare that the information provided is true and complete, and understands that furnishing false information or suppressing factual information could lead to disqualification or termination from employment.

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    Note: Please Download The Antecedent Verification Form and Submit 2 Copie's of The Same Duly Signed by You at The Time of Verification

    Uploaded by

    ChowdaihPujala
    222 views4 pages
    1. The document is an antecedent verification form that collects personal and background information from a candidate named Pujala Chowdaiah who has applied for a post under Category II Group B. 2. It requests information about the candidate's identity, family, education history, residential history, criminal history, and responsible persons who can verify the candidate's identity and background. 3. The candidate is asked to declare that the information provided is true and complete, and understands that furnishing false information or suppressing factual information could lead to disqualification or termination from employment.

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    1. The document is an antecedent verification form that collects personal and background information from a candidate named Pujala Chowdaiah who has applied for a post under Category II Group B. 2. It requests information about the candidate's identity, family, education history, residential history, criminal history, and responsible persons who can verify the candidate's identity and background. 3. The candidate is asked to declare that the information provided is true and complete, and understands that furnishing false information or suppressing factual information could lead to disqualification or termination from employment.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    222 views4 pages

    Note: Please Download The Antecedent Verification Form and Submit 2 Copie's of The Same Duly Signed by You at The Time of Verification

    Uploaded by

    ChowdaihPujala
    1. The document is an antecedent verification form that collects personal and background information from a candidate named Pujala Chowdaiah who has applied for a post under Category II Group B. 2. It requests information about the candidate's identity, family, education history, residential history, criminal history, and responsible persons who can verify the candidate's identity and background. 3. The candidate is asked to declare that the information provided is true and complete, and understands that furnishing false information or suppressing factual information could lead to disqualification or termination from employment.

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    Note : Please Download the Antecedent Verification Form and submit 2 copie's of the same duly
    signed by you at the time of Verification

    Antecedent Form

    Personal Details

    VSWS HallTicket
    191105004920
    Number

    Applicant Name PUJALA CHOWDAIAH

    Post Applied POSTS UNDER CATEGORY - II GROUP - B

    Date Of Birth of
    04/08/1991
    Applicant

    Mobile 8977814438

    Religion HINDU

    Community BC-B

    Community Sub
    Thogata, Thogati or Thogataveerakshtriya
    Caste

    Place Of Birth JAMMALAMADUGU

    District To Which
    KADAPA
    Belong

    Martial Status UNMARRIED

    Present District KADAPA

    Present Address 4/127,JAMMALAMADUGU,JAMMALAMADUGU,Jammalamadugu,516434

    Permanent
    KADAPA
    District

    Permanent
    4/127,JAMMALAMADUGU,JAMMALAMADUGU,Jammalamadugu,516434
    Address

    PRECEEDING RESIDENTIAL DETAILS

    Sl.No From Month/Year To Month/Year Residential Address Police Station & District

    1 06/2012 06/2013 CHINNATEKUR,KURNOOL ULINDALONDA,KURNOOL


    PRECEEDING RESIDENTIAL DETAILS

    Sl.No From Month/Year To Month/Year Residential Address Police Station & District

    2 06/2011 06/2012 CHINNATEKUR,KURNOOL ULINDALONDA,KURNOOL

    3 06/2010 06/2011 CHINNATEKUR,KURNOOL ULINDALONDA,KURNOOL

    4 06/2009 11/2010 CHINNATEKUR,KURNOOL ULINDALONDA,KURNOOL

    5 06/2008 06/2009 PRODDATUR,KADAPA PRODDATUR,KADAPA

    Father Details

    Father Name PUJALA RAMADASU

    Profession/Job No

    Postal District KADAPA

    Postal Address 4/127,NEHRINAGAR,JAMMALAMADUGU,Jammalamadugu,516434

    Permanent District KADAPA

    Permanent Address 4/127,NEHRINAGAR,JAMMALAMADUGU,Jammalamadugu,516434

    EDUCATION QUALIFICATION DETAILS

    Examination
    Name Of School/College Entering Leaving RegNo & Police Station &
    Course
    Address Date Date Passed District
    Details

    SAI BABA
    SSC/Matriculation 03/2005 03/2006 EE315757 JAMMALAMADUGU,KADAPA
    HIGHSCOOL,JAMMALALAMADUGU

    BHAVANA JUNIOR
    Intermediate/Diploma 04/2006 05/2008 H193354 PRODDATUR,KADAPA
    COLLEGE,PRODDATUR

    KOTTAM KARUNAKAREDDY
    Graduation/Professional
    INSTITUE OF TECHNOLOGY 06/2009 06/2013 PC0100026 KURNOOL,KURNOOL
    Course
    KURNOOL

    Post Graduation --- --- --- --- ---

    Any other Qualification --- --- --- --- ---

    Case Details

    Is Arreted By Police.convicted by Court Of Law


    No
    Under any state/central Laws

    Have you ever been arrested No

    Have you ever been prosecuted No

    Have you ever been kept under detention No

    Have you ever been bound down No


    Have you ever been fined by a Court of Law No

    Have you ever been convicted by a court of Law No

    Have you ever been debarred from any examination


    or rusticated by
    No
    any university or any other educational
    authority/institution

    Have you ever been debarred /disqualified by any


    Public Service
    Commission/Staff Selection Commission/or any No
    other recruitment
    board for any of its examination/selection

    Is any case pending against you in any court of law


    at No
    the time of filling up this Antecedents form

    Is any case pending against you in any University or


    other educational
    No
    authority/institution/ at the time of filling of this
    Antecedents Form?

    Whether discharged/expelled/with drawn from any


    training/institution under No
    the Government or otherwise?

    RESPONSIBLE PERSON DETAILS

    First Preference Second Preference

    Name in Full Sur Name PUJALA CHANDRASEKAR PUJALA RAMADEVI

    Given Name If Any -- --

    Fathers Name PUJALA RAMADASU PUJALA SREERAMULU

    House/Apart/Flat No 4/127 4/18-18C

    Street and Road NEHRUNAGAR NEHRUNGAR

    Village JAMMALAMADUGU JAMMALAMADUGU

    Mandal/Taluk Jammalamadugu Budwel

    Town/City Election Ward No. 14 Election Ward No. 14

    District KADAPA KADAPA

    Pin Code 516434 516434

    Urban/Rural URBAN URBAN

    DECLARATION DETAILS
    1. I hereby declare that the statements made In this form are true to the best of my knowledge and belief.
    2. I am married / unmarried and have only one wife living ( delete which Is not applicable).
    3. I am fully aware that furnishing of false Information or suppression of any factual Information in the Antecedents
    Form would be a disqualfication and is likely to render me unfit for employment under the Government.
    4. I am also fully aware that If It comes to notice at any time during my service that false Information has been
    furnished or that there has been suppression of factual Information in the Antecedents Form, my services would be
    liable to be terminated solely on this ground.
    Date Signature of the Candidate
    Place (Full Name:                  )
    Designed and Developed by Andhra Pradesh Centre for Financial Systems and Services

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