Junior Clerk

10/5/2015
Server1WelcometoOdishaStaffSelectionCommission
ODISHASTAFFSELECTIONCOMMISSION
BarrackNo.1,UnitNo.V,Bhubaneswar751054|Tel:06742393770|Fax:06742391153
150839018131
ApplicationForm
ApplicantCopy(Toberetainedbytheapplicant)
1. PostCodeandName
2. AdvertisementNo.andDate
3.
Choiceofdistrictforappearing
intheexamination
39
JuniorAssistantAndJuniorClerk
15Aug2015
4282
Malkanagiri
4. FullNameOftheApplicant
Mr.TapanKumarSarkar
5. Father'sName
Mr.BishnupadaSarkar
6. Mother'sName
Mrs.SaraswatiSarkar
7. NameofthehusbandincaseofMarriedfemaleapplicant
NA
8.PersonalDetails
a. Nationality
Indian
Hindu
NCC
Reservation
Certificate
g.
Category
received,if
any
f.
SC
NA
WhetherEx
Serviceman
j.
Whether
holderof
n. Sports
Person
Certificate
No
d. DateofBirth.
Male
25Oct1992
e. Ageason01Jan2015
Year 22
h. PhysicallyChallenged(Yes/No)
No
No
NA
o.
NA
Yes
IDcardno.issuedbyDirectorofSports(incaseof
p. StateLevelMedal
SportsPerson)
No
r. InternationalLevelMedal
s.
InService(Govt.
Contractual)
No
No
From
Month
i. TypeofPhysicaldisability
NA
National
LevelMedal
q.
c. Sex
Periodof
Service
Whetherpassed
Date/LikelyDateofDischarge(in
k. rendered(in l.
m. minimumSeventh
caseofExServiceman)
caseofEx
classExam.inOdia
Serviceman)
NA
No
t.
b. Religion
u. To
v.
TotalInService
Experience
0.0
9.AddressforCorrespondence(AllCommunicationtothecandidatefromOSSCistobemadeinthisaddress)
a.
Addresswith
Pincode:
BalimelaRoad.P.O/P.SMalkangiri,Pincode:764045
b. District:
Malkanagiri
d. Telephone:
c. State:
e. Mobile:
f. eMail:
8763734374
Odisha
xtapan@gmail.com
10.PermanentAddress
a.
Addresswith
Pincode:
b. District:
Malkanagiri
c. State:
Odisha
11.EducationalQualification
10thStandardRollNumberAsMentionedintheCertificate
03PF121
10thStandardExamType
Annual
http://online.odishassc.in/Form/R_PrintOnlineForm_N.aspx?ApplicantId=150839018131
1/5
10/5/2015
Examination
Stream
Board/University
YOP
Division
TotalMarks/CGPA
SecuredMarks/CGPA
%Age
HSC
***
BSE,ODISHA
2007
Second
750
416
55.46
10+2/Equivalent
SCIENCE
CHSE,ODISHA
2009
First
600
435
72.50
12.Workexperiencedetails.(IfinGovt.Service)
NameofthePostheld:
Whether
From:
Whetherappointedfollowingdue
procedure
To:
13.TreasuryChallanDetails(OriginalChallanhastobesubmittedalongwiththehardcopyoftheapplication)(Candidates
belongingtoSC/ST/PWDCategoriesareexemptedfrompayingtheexamfees.)
TreasuryChallan/Reference
Number:
NA
Date:
NA
NameofTreasury
NA
Amount
ProficiencyinComputerKnowledge
Yes
14.ApplicationDetails
ApplicantId:
150839018131
Password: DD6D7D8A71
NB:YourOnlineapplicationhasbeensubmittedsuccessfully.
2/5
10/5/2015
ODISHASTAFFSELECTIONCOMMISSION
BarrackNo.1,UnitNo.V,Bhubaneswar751054|Tel:06742393770|Fax:06742391153
150839018131
ApplicationForm
OSSCCopy
JuniorAssistantAndJuniorClerk
2. AdvertisementNo.andDate
3.
39
1. PostCodeandName
15Aug2015
4282
Choiceofdistrictfor
appearingintheexamination
Malkanagiri
4. FullNameOftheApplicant
Mr.TapanKumarSarkar
5. Father'sName
Mr.BishnupadaSarkar
6. Mother'sName
Mrs.SaraswatiSarkar
7. NameofthehusbandincaseofMarriedfemaleapplicant
NA
8.PersonalDetails
a. Nationality
b. Religion
Indian
f.
Reservation
Category
Hindu
g.
SC
j.
d.
Male
NCC
Certificate
received,if
any
NA
WhetherEx
Serviceman
c. Sex
NA
Year
25Oct1992
Physically
h. Challenged
(Yes/No)
i.
No
q.
m.
Whetherpassedminimum
SeventhclassExam.inOdia
NA
Yes
NA
NationalLevel
Medal
No
t. From
StateLevelMedal
s.
InService(Govt.
Contractual)
v.
TotalInService
Experience
No
u. To
p.
No
r. InternationalLevelMedal
No
TypeofPhysicaldisability
Whetherholder
IDcardno.issuedbyDirectorofSports(incaseofSports
n. ofSportsPerson o.
Person)
Certificate
No
Month
22
NA
Periodof
Date/Likely
Service
Dateof
k. rendered(in l. Discharge(in
caseofEx
caseofEx
Serviceman)
Serviceman)
No
DateofBirth. e. Ageason01Jan2015
0.0
9.AddressforCorrespondence(AllCommunicationtothecandidatefromOSSCistobemadeinthisaddress)
a.
Addresswith
Pincode:
b. District:
Malkanagiri
d. Telephone:
c. State:
e. Mobile:
f. eMail:
8763734374
Odisha
xtapan@gmail.com
10.PermanentAddress
a.
Addresswith
Pincode:
b. District:
c. State:
Malkanagiri
Odisha
11.EducationalQualification
10thStandardRollNumberAsMentionedintheCertificate
03PF121
10thStandardExamType
Annual
Examination
Stream
Board/University
YOP
Division
TotalMarks/CGPA
SecuredMarks/CGPA
%Age
3/5
10/5/2015
HSC
***
BSE,ODISHA
2007 Second
750
416
55.46
10+2/Equivalent
SCIENCE
CHSE,ODISHA
2009 First
600
435
72.50
12.Workexperiencedetails.(IfinGovt.Service)
NameofthePostheld:
From:
Whether
Whetherappointedfollowingdue
procedure
ProficiencyinComputerKnowledge
To:
Yes
13.TreasuryChallanDetails(OriginalChallanhastobesubmittedalongwiththehardcopyoftheapplication)
(CandidatesbelongingtoSC/ST/PWDCategoriesareexemptedfrompayingtheexamfees.)
TreasuryChallan/Reference
Number:
NA
Date:
NA
NameofTreasury
NA
Amount
DECLARATION
I __________________________ Son/ Daughter of Shri _________________________Age___________ Year__________
residentof________________District________________herebydeclarethattheinformationgivenaboveandintheenclosed
documentsistruetothebestofmyknowledgeandbeliefandnothinghasbeenconcealedtherein.Iamwellawareofthefactthat
iftheinformationgivenbymeisprovedfalse/nottrue,Iwillhavetofacethepunishmentasperthelaw.Also,allthebenefits
availedbymeshallbesummarilywithdrawn.
Signatureshouldnotexceedtheboxprovided
Date:
Place:
FullSignatureoftheApplicant(InkSigned)
4/5
10/5/2015
Sender
By
Post
From
ApplicationforthePostof:Junior
AssistantAndJuniorClerk
Name
Mr.TapanKumarSarkar
Father'sName
Mr.BishnupadaSarkar
To
PlotNo,/Lane
BalimelaRoad.P.O/P.S
TheSecretary,
Name/Village
Malkangiri
OdishaStaffSelectionCommission,
DistrictName
Malkanagiri
PINCode
764045
BarrackNo.1,
UnitNo.V,
Bhubaneswar751054.
Tel:06742392233
Fax:06742391153
5/5

Junior Clerk

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10/5/2015

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