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ON-LINE APPLICATION FOR RECRUITMENT OF SOCIAL SECURITY ASSISTANT

25034

Registration # : Full name: Category :

1039813 Swati Balia SC

Are you an Employee of Central Government or Employees' Provident Fund Organization ? : NO Quota : If physically Challenged : Type of Disability : Category of Disablement : Percentage of disability : Do you intend to use the services of a scribe? : Are you an Ex - Serviceman ? : Period of Service as an Ex-Serviceman (in months) : Nationality : Name of Region : Examination Centre : Centre code : Application Fee / Postal Charges Details : Payment IN : Journal No : Branch Name : Branch Code number : Deposit Date : Amount : Personal Details : Date of Birth : Age completed(as on 09.03.2012) : Gender : Father's Name / Husband's Name : Mother's name : Address for Correspondence : 05-02-1989 23 FEMALE Shri Veer Bhoj Balia Smt Kamlesh Balia Sector 7 Flat No 331 R K Puram New Delhi State : Pin : Permanent Address : DELHI 110022 Sector 7 Flat No 331 R K Puram New Delhi State : Pin : DELHI 110022 State Bank of India 004002772 Vasant vihar 1604 23-02-2012 90 None NO NA NO -Indian Delhi Delhi 15

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Contact Details: Email ID : Phone No : Mobile No: Qualification Details (as on 09.03.2012): Exam Passed Graduation/Equivalent : Working Knowledge of Computers : Details of Computer Knowledge : Post Qualification Work experience details (Start from present Employer) : Name of the Employer Designation From(mm/yyyy) To(mm/yyyy) Nature of Duties Performed Reason for Leaving Length of Service (YY/MM) Name of the Course/Degree BA Prog Year of Passing 24-08-2011 YES Basics % of Marks 39.75 Class / Grade Pass Class swatiwalia1989@gmail.com 011-26195204 9654599122

Total Experience (in months) :

DECLARATION:
I hereby declare that i. I declare that I fulfill all the conditions of eligibility regarding age limits, educational qualifications etc, prescribed for admission to the examination for the quota / category under which I have applied. ii. All the statements made in this application are true , correct and complete to the best of my knowledge and belief, and if any of the particulars furnished by me are found to be incorrect or suppressed, or my ineligibility being detected before or after the examination, my candidature is liable to be rejected at any stage of the selection process. Even if it is found after my appointment in EPFO that the particulars furnished by me were incorrect , false, incomplete or suppressed, my services would be liable to be terminated without any notice. iii. I also declare that I do not stand debarred by any organisation under the Government of India as on date and have never been convicted by any court of law. I also declare that no charge sheet is pending against me in any court of law. Further declare that I have never been dismissed or removed from Govt Service or my service been terminated during probation. iv. I agree that my final appointment shall be subject to my fulfilling all the conditions / eligibility criteria as per rules applicable for the category / quota under which I have applied. v. For Candidate belonging to Ex-Serviceman I declare that I fulfill all the eligibility conditions relating to EX-Serviceman as per rules existing in this regard. vi. For candidates belonging to Sports Quota I declare that I fulfill all the eligibility conditions relating to recruitment of meritorious Sports persons as per advertisement / rules existing in this regard. vii. In case of my selection I am willing to serve anywhere in India.

Place: Date: 23-02-2012 Signature of Applicant

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