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ON-LINE APPLICATION FOR RECRUITMENT OF CLERICAL CADRE

29041
Registration # : 3000843812

Full Name :

RUMA PATRA

State/UT Applied for : Category : If Person with Disability : Type of Disability : Percentage of Disability :

West Bengal OBC NO -

Do you intend to use the services of a scribe (only for VI & OH candidates whose writing NA speed is affected by cerebral palsy) ? : Are you candidate who had ordinarily been domiciled in Kashmir Division of the State of J & K during the period 1-1-1980 to 31-12-1989 ? : Whether you belong to Religious Minority Community ? : Religion to which you belong : Are you an Ex-Serviceman ? : Are you Disabled Ex-Serviceman (DXS) ? : Are you a Matriculate ? : Have you obtained the Indian Army Special Certificate of Education or corresponding certificate in the Navy or the Air Force, after having completed not less than 15 years of service in Armed Forces of the Union : Are you Dependent of an Ex-Serviceman killed in action ? : Are you seeking relaxation under widow /divorced women / women judicially Separated from their husbands and who are not re-married ? : Nationality / Citizenship : Centre of Examination : Centre Code : Application Fee / Intimation Charges details: Payment Mode: Amount : Personal Details : Date of Birth : Age completed as on 01.12.2011 : Gender : Husband's Name/Father's Name : Mother's Name : Address for Correspondence : 08-07-1988 23 FEMALE KALI PADA PATRA SUMITA PATRA C/O- DEEPAK TIRKEY NEW NAGAR BANDHGARI DIPATOLI District State : Pin : Permanent Address : RANCHI JHARKHAND 834009 VILL+PO- PETBINDHI PS- BELIABARA District State : PASCHIM MIDNAPUR WEST BENGAL ONLINE 350.00 NO NO INDIAN Kolkata 54 NO NO NO NO

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Pin : Contact Details : Email ID : Phone No : Mobile No : Qualification Details (as on 01.12.2011): Exam Passed SSC/Equivalent : HSC/ 12th(10+2) / Equivalent : Graduation/Equivalent : Other Details : Would You like to undergo Pre-Exam Training (SC/ST/Minority Community/ XS / DXS / Dependents of XS) : If Yes Centre for Training : Languages Known English HINDI BENGALI Read YES YES YES --Write YES YES YES Speak YES YES YES Subject /Stream ENG HIN SC MATH SST SCIENCE BSC Date of Passing 24-05-2003 23-05-2005 09-07-2009 % of Marks 59.00 71.60 55.00 patraruma@yahoo.co.in 9504336750 721517

DECLARATION:
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 untrue or incorrect at any stage or my not satisfying any of the eligibility criteria according to the Central Recruitment & Promotion Department, my candidature is liable to cancelled. I am willing to serve anywhere in India including rural areas.

Place:

Date: 20-01-2012

Signature of Applicant

Please retain your Registration No. and Password emailed to you carefully for further reference NOTE: Please DO NOT SEND application printout to CRPD/ SBI