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ON-LINE APPLICATION FOR TNPSC REGISTRATION

33031
Registration # :

419153406

Notification. No. :

18/2014

Full Name :

S DURGA

Do you have One Time Registration ID? :

YES

One Time ID :

13055637

Name of The Post Applying for :

Junior Assistant/Bill Collector/Field Surveyor/Draughtsman

Are you a Destitute Widow? :

NO

Are you a Differently Abled Person? :

NO

Are you an Ex-Serviceman ? :

NO

PPO No :

--

Date of Discharge / Probable date of Discharge :

--

Are you a Government Employee? :

NO

Nationality :

Indian

Application Fee / Intimation Charges details:

Payment Mode:

Net Banking

Amount :

75.00

Personal Details :
Date of Birth :

05/05/1992

Gender :

FEMALE

Marital Status :

Married

Spouse's Name :

SELLAPPAN

Religion :

Hindu

Candidate's Place of Birth :

DINDIGUL

Native District :

Dindigul

Father's Name :

P SELVAM

Father's Place of Birth :

Dindigul

Mother Tongue :

Tamil

Mother's Name :

S SARASWATHI

Communal Category :

Backward Class(BC)

Name of the SubCaste :

ThuluvaVellala

Certificate No :

419887

Date Of Issue :

10/08/2007

Issuing Authority :

Deputy Tahsildar (Certificates)

Taluk :

Vedasandur

District :

Dindigul

Address for Correspondence :

4/98,NALLAMANAR KOTTAI
NALLAMANAR KOTTAI POST
VEDASANDUR TALUK

District

Dindigul

State :

Tamil Nadu

Pin :

624005

Permanent Address :

4/98,NALLAMANAR KOTTAI
NALLAMANAR KOTTAI POST

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NALLAMANAR KOTTAI POST

VEDASANDUR TALUK
District

Dindigul

State :

Tamil Nadu

Pin :

624005

Contact Details :
Email ID :

gajendranselvam@gmail.com

Mobile No :

9500047835

EDUCATIONAL QUALIFICATION PARTICULARS :

Exam Passed

Date of
Publication of

S.S.L.C :

31/05/2007

H.S.C or Equivalent
Qualification :

14/05/2009

Medium of
Instruction

Degree

Major Subject

Board /
University

Tamil

N/A

N/A

STATE BOARD

Tamil

H.S.C

Results

N/A

STATE BOARD

Others :

--

Do you claim reservation for Persons Studied in Tamil Medium (PSTM)? :

Yes

Date Of Issue of PSTM certificate :

14/03/2009

Issuing Authority :

GOVT HR SEC SCHOOL HEAD MASTER

Are you trained person in Survey in ITI, Tamil Nadu?

(Eligible for Field Surveyor and Draughtsman post only)? :

No

Whether you are applying with the Educational Qualification as Prescribed in

Prescribed Qualification
the notification or with an equivalent qualification :
Details regarding the prescribed qualification :
Qualification Details :

SSLC

Certificate No :

4252898

Year of Passing :

2009

Name of the Authority/ University :

GOVT HR SEC SCHOOL ERIYODU

Preferential qualification for per notification :

No
English

Type writing / Short hand Qualification

Cert. No. Issued by Dir. of

Cert. No. Issued by Dir.
Tamil
Technical Education
of Technical Education

Type
Writing

--

--

--

--

Short
hand

--

--

--

--

Computer Qualification (for Typist and Steno-Typist, Grade III) ?

Do you possess Certificate Course in Computer on Office Automation
awarded by the Technical Education Department? :

No

Physical Standards as per notification :

Yes

Name of the Examination Centre District:

Dindigul

Name of the Examination Centre :

Dindigul

Optional Subject :

General Studies with General Tamil (S.S.L.C Standard)

Do you claim Age Concession? :

No

Do You Claim Fee Exemption? :

No

Criminal Case (Registered/Pending/Punishment awarded) :

Not Applicable

Participation in Political Activities (In agitation/As a Member of Political

Organisation/Candidature in Election) :

Not Applicable

Experience Details :
Name of the Organisation

Designation

From(mm/yyyy)

To(mm/yyyy)

Nature of Duty

Previous appearance for Oral Test / Written Test

Name of the Post

Register No.

Year

--

--

--

--

--

--

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DECLARATION:
1. I hereby declare that all the particulars furnished in this application are true, correct and complete to the best of my knowledge and belief. In the event of any information being found false or
incorrect or ineligibility being detected before or after the examination, action can be taken against me by the TNPSC.
2. I hereby declare that I will not be a party to any kind of canvassing on my behalf.

3. I further declare that I fulfil all the eligibility conditions prescribed for admission to the examination.

4. I have informed my employer in writing that I am applying for this Examination.

5. I have gone through the Instructions etc. to candidates and the Commissions notification for this Recruitment before filling up the application form.

6. I declare that I possess the medical standards prescribed for the post(s) which I am now applying.

7. I Certify that I have not been debarred / disqualified by the TNPSC or any other recruiting agency.

8. I am not a dismissed Government Employee.

I accept the above declaration

Place:

Date: 2014-11-10 20:58:35

Please retain your Registration No. and Password emailed to you carefully for further reference

Signature of Applicant