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    Applicationform Draft Print For All

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    lucifer.morningstar.333639

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    © All Rights Reserved
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    Applicationform Draft Print For All

    Uploaded by

    lucifer.morningstar.333639
    6 views3 pages

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    Applicationform Draft Print for All

    Copyright

    © © All Rights Reserved

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    Copyright:

    © All Rights Reserved
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    6 views3 pages

    Applicationform Draft Print For All

    Uploaded by

    lucifer.morningstar.333639

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 3

    STAFF SELECTION COMMISSION

    BLOCK NO. 12, CGO COMPLEX, LODHI ROAD, NEW DELHI


    110003
    CONSTABLES (GD) IN CENTRAL ARMED POLICE FORCES
    (CAPFs), SSF AND RIFLEMAN (GD) IN ASSAM RIFLES
    EXAMINATION 2024

    REGISTRATION NO: 30006661102

    APPLICATION IS INCOMPLETE

    1. NAME AS PER MATRICULATION 2. NEW/CHANGED


    3. FATHER'S NAME 4. MOTHER'S NAME
    CERTIFICATE NAME
    ARBAZ QURESHI - AQEEL SITARA
    5. DATE OF BIRTH (DD/MM/YYYY) 6. AGE AS ON 01/01/2024 7. GENDER 8. CATEGORY
    11/08/2004 19.4 MALE OBC
    9. NATIONALITY 10. MARK OF VISIBLE IDENTIFICATION
    CITIZEN OF INDIA AADHAR CARD
    12. MATRICULATION (10th 13. MATRICULATION (10th
    11. MATRICULATION (10th CLASS) EXAMINATION BOARD
    CLASS) ROLL NO CLASS) YEAR OF PASSING
    CENTRAL BOARD OF SECONDARY EDUCATION (CBSE) 21206447 2020
    14.1. WHETHER YOU ARE AN EX-SERVICEMEN (ESM) OR
    14.2. DATE OF JOINING THE ARMED FORCES (DD/MM/YYYY)
    SERVING IN THE ARMED FORCES?
    NO -
    14.3. DATE OF DISCHARGE FROM ARMED FORCES
    14.4. LENGTH OF SERVICE IN THE ARMED FORCES
    (DD/MM/YYYY)
    - -
    14.5. HAVE YOU ALREADY JOINED A CIVIL POST BY
    AVAILING BENEFIT OF RESERVATION FOR EX-SERVICEMEN 14.6. DATE OF JOINING TO CIVIL POST (DD/MM/YYYY)
    (ESM) ?
    - -
    15.1. WHETHER SEEKING AGE RELAXATION? 15.2 IF YES, AGE RELAXATION CODE
    NO -
    16.1. ARE YOU A NATIONAL CADET CORPS (NCC)
    16.2. TYPE OF THE NCC CERTIFICATE
    CERTIFICATE HOLDER
    NO -
    17. PREFERENCE OF EXAMINATION CENTRES

    EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER


    ( FIRST PREFERENCE ) ( SECOND PREFERENCE) ( THIRD PREFERENCE)

    AGRA ( 3001 ) BAREILLY ( 3005 ) MEERUT ( 3011 )

    18. MEDIUM FOR COMPUTER BASED 19. STATE/ UT OF DOMICILE 20. DISTRICT OF DOMICILE
    EXAMINATION (CBE)
    ENGLISH UTTAR PRADESH MATHURA
    21.1. HAVE YOU MIGRATED FROM THE STATE/ UT OF 21.2. WHETHER YOU WOULD LIKE TO AVAIL THE BENEFIT OF
    YOUR ORIGIN TO ANOTHER STATE/ UT RESERVATION FROM THE STATE/ UT OF YOUR ORIGIN
    NO -
    21.3. STATE/ UT OF ORIGIN 21.4. DISTRICT OF ORIGIN
    - -
    22. CANDIDATE BELONGS TO MILITANCY/ NAXAL
    23. CANDIDATE BELONGS TO BORDER DISTRICT
    AFFECTED DISTRICT
    NO NO
    24. PREFERENCE OF POST FOR CAPF(S)/ ORGANIZATION(S)
    H,B,C,F,E,A,D,
    25. HIGHEST EDUCATIONAL QUALIFICATION
    BA (5)
    26. DETAILS OF QUALIFYING EDUCATION
    10TH STANDARD
    STATUS PASSING STATE/ UT OF BOARD/ NAME OF BOARD/ ROLL NO PERCENTAGE CGPA
    YEAR UNIVERSITY UNIVERSITY
    PASSED 2020 DELHI CENTRAL BOARD OF 21206447 75 -
    SECONDARY
    EDUCATION (CBSE)
    27. DO YOU WANT TO MAKE AVAILABLE YOUR PERSONAL INFORMATION FOR ACCESSING JOB OPPORTUNITY IN TERMS OF
    DoP&T'S O.M NO.39020/1/2016-ESTT.(B) DATED 21.06.2016 ?
    YES
    ADDRESS DETAIL
    28. CORRESPONDENCE ADDRESS 29. PERMANENT ADDRESS
    JYOTI NAGAR NEAR POOJA MEDICAL STORE MATHURA JYOTI NAGAR NEAR POOJA MEDICAL STORE MATHURA
    DISTRICT: MATHURA DISTRICT: MATHURA
    STATE: UTTAR PRADESH STATE: UTTAR PRADESH
    PIN: 281004 PIN: 281004
    MOBILE NO. : 7453015398 EMAIL ID: [email protected]
    30. WHETHER PHOTOGRAPH HAS BEEN TAKEN ON OR AFTER 24-AUGUST-2023?
    YES
    FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE

    NOT EXEMPTED 100 - -


    DECLARATION
    1. I HAVE READ THE NOTICE OF THE EXAMINATION AND ACCEPT ALL THE TERMS & CONDITIONS OF THE NOTICE
    OF THE EXAMINATION.

    2. I HEREBY DECLARE THAT ALL 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 OR AFTER THE
    EXAMINATION, MY CANDIDATURE/ APPOINTMENT IS LIABLE TO BE CANCELLED.I AM WILLING TO SERVE
    ANYWHERE IN INDIA.

    3. I DECLARE THAT THE PHOTOGRAPH UPLOADED IN THE APPLICATION FORM HAS BEEN TAKEN ON OR AFTER THE
    STIPULATED DATED.

    4. I AGREE TO AUTHORIZE SSC TO USE MY AADHAR DATA FOR VERIFICATION PURPOSE.


    PRINT TAKEN ON: 17/12/2023 12:07:49 PM IP ADDRESS: 49.36.219.231

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