Transcription of APPLICATION FORM COMBINED COMPETITIVE …
1 APPLICATION FORMCOMBINED COMPETITIVE (PRELIM.) EXAMINATION, 2018 (To be filled in by the candidate with good quality black/blue ball pen in capital letters in appropriate box)2. Centre Opted(as per Advertisement)3. Gender(Female-F)(Male- M)4. Educational Qualification Year of Passing7. Category(GEN/SC/STP/STH/OBC&MOBC)5. (a) Date of Birth (As per HSLC Certificate)(b) Age as on 01-01-20186. Are you a permanent resident of Assam? (YES/NO)10. Name (as recorded in HSLC or equivalent certificate in BLOCK LETTER IN ENGLISH) Leave one blank space each in between parts of the name.
2 11. Father s Name (Leave one blank space each in between parts of the name)12. Mother s Name (Leave one blank space each in between parts of the name)13. Type of Disability (PWD candidate) Locomotor Disability- OHHearing Impaired-HIVisually Impaired-VI If so, Degree of Disability(%) 14. Departmental Candidate (YES/NO) 8. Ex-Serviceman (YES/NO)9. Nationality16. Optional Subject(Indicate ONLY ONE change once submitted) 17. Address for Correspondence: 18. Permanent Address: Name: _____Vill/Lane/Road:_____House :_____Pin:_____Place: Date: ---------------------------------------- Signature of Candidate(in full) Certificates from proper authority must be furnished for Sl.
3 ,5(a), 7,8,14 and from concerned authorities of Social Welfare Deptt. for Sl. without PHOTOGRAPH and SIGNATURE of the candidate will be summarily ID of the BankNo. & Date of Treasury ReceiptValueLast date of receipt of APPLICATION : DDMMYYYYYYMMDDName: _____Vill/Lane/Road:_____House :_____Pin:_____I hereby declare that all statements made in this APPLICATION are true, complete and correct to the best of my knowledge and belief. In the event of any information being found false or ineligibility being detected before or after the examination, action may be taken against me by the Commission as may deem have read the terms and conditions of the Commission as published in the advertisement carefully and I do hereby undertake to abide by any other terms and conditions as may be applicable to further declare that I fulfill all the conditions regarding Age, Educational Qualification, etc.
4 Prescribed for admission to the examinationI certify that I have not been debarred by any examination conducting authority. DECLARATION 1. Details of fee to be paid:(I) For Open Category : Rs. (II) For SC/ST/MOBC/OBC : Rs. (III) For Candidates having BPL certificate/PWD candidates : NIL (Photocopy of certificate to be produced along with the APPLICATION form ) Photograph: Paste your recent good quality passport size ( x )cm photograph.
5 Please do not one identical photograph with you for use in further stage of Recruitment. (Please Sign in the box below in blackball pen) Have you ever been debarred from applying for any Govt. Post? (YES/NO)(Graduate-I) (Post Graduate & above-II)(For Official use only)
