10/4/2016

UttarPradeshSubordinateServicesSelectionCommission,Lucknow

,
IDeclarethatihaveReadthedetailedUserManul&Notification.

NotificationDetails(DirectRecruitment)

AdvertisementNumber: 18(5)/2016

AppliedFor:

TypeofRecruitment:

General

Director,Technical
Education,Uttar
Pradesh,Kanpur./
WorkshopInstructor
MachineShopGovt
Polytechnic,

Candidate'sPersonalDetails

ApplicationID:

200003525000073

RegistrationNo.:
52500042989
Father's/Husband'sName
CandidateName:
VIJAYBAHADURPAL
SHIVLOCHANPAL
:
DomicileofUP/
GenderDateofBirth: Male08/08/1994
Yes/SC
Category:
9935672472
AreyouMarried?
Yes
ContactNo./EmailID:
/vijay080894@gmail.com
BankTransactionDetails

BankNamePayment
Mode:

StateBankOfIndia
STATEBANKINB

Fees,TransactionID
Date:

Rs.25.00,DU54622611
02/10/2016

OtherDetailsofCandidate

AreyouDependentofUPFreedom
Fighter?

No

ServiceDuration(DayMonthYear):

0
0
0

AreyouECO/SSCO/COofArmy?
Haveyourservicesbeenextendedfor
rehabilitationandnodisciplinaryaction
ispendingagainstyou?
CompletionDateofDebarment
(DD/MM/YYYY):
AreyouBlindOrHaveVisionproblem?
:

AreyouUPEx.Army?

No

RetirementDate(Date/Month/Year):

___

Haveyoucomplete5yearservice? No
HaveyoueverbeenDebarredfromU.P.
No
SubordinateServicesSelection
Commission?:

No

No
../../....

AreYouHandicapofUP?

No

AreyouDeaforHavehearingproblem?
No
:

Yes

HaveyouanyphysicalProblem?:

Yes

Sr.No. PHCategory[LOCOMOTORorCEREBRALPLASY]

SelectedPHCategory

16.3.1 BothLegsaffectedbutnotarms[BL]

BL

16.3.2 BothArmsaffected[BA]

BA

16.3.3 BothLegsandBothArmsaffected[BLA]

BLA
OLYes

16.3.4 OneLegaffected(rightorleft)[OL]

ImpairedReach

16.3.5 OneArmaffected(rightorleft)[OA]

OA

16.3.6 SiffBackandHips(Cannotsitorstoop)[BH]

BH

16.3.7 MuscularWeaknessandlimitedphysicalendurance[MW]

MW

AreYouSkilledPlayerOfUP?:

Weaknessofgrip

Ataxic

No
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10/4/2016

AreYouGovt./ExGovt.StateEmployee No
ofUttarPradesh?

HighSchool&IntermediateBoard,Yearofpassing&RollNumberDetails

Sr.No Examination BoardName

Yearof
Passed
Passing
UTTARPRADESHBOARDOFHIGHSCHOOLAND
2008
1.
HighSchool

Roll
Obtained Total
Number Marks
Marks
1532505

387

600

2.

N/A

N/A

N/A

INTERMEDIATEEDUCATION
Intermediate N/A

N/A

EssentialQualificationDetails

Is
Obtain Total Percentage
Acquired Grade
Marks Marks (%)
System

Sr
Qualification
No.
1
2

3YearcertificateintheconcernedTradefromGSTSorHighSchoolwithcertificatein
Yes
theconcernedTradeofITIGITIPolytechnicorDiplomainrespectivebranch.
3Yearpostcertificateindustrialexperience.
Yes

No

1538.002200.0069.91

N/A

N/A

N/A

N/A

PreferentialQualificationDetails

Sr
Qualification
No.
Acandidatewhohas(1)ServedintheTerritorialArmyforaminimumperiodoftwoyearsor(2)ObtainedBcertificateof
1
NationalCadetCorpsshallotherthingsbeingequalbegivenpreferenceinthematterofdirectrecruitment.

Acquired
No

Candidate'sAddress,PhotoSignatureDetails

AddressDetails
Candidate's
Candidate'sPermanentAddress

Correspondence/MailingAddress

Address/Name
:
House
no./Village:
StreetNo./PO:
CityName:
State/District
Name:
PIN:

VIJAYBAHADURPAL

VIJAYBAHADURPAL

CHAUKTHANARVAR

CHAUKTHANARVAR

AUNTA
ALLAHABAD

AUNTA
ALLAHABAD

Photo&Signature

UttarPradesh/ALLAHABAD UttarPradesh/ALLAHABAD
212303

212303

Iacceptthefollowingdeclaration: Yes

1.IherebydeclarethatIhavereadallterm&conditionaccrodingadvertisementandIacceptit.
2.Iherebydeclarethatalltheentires/statementsmadeinthisapplicationaretrue,completeandcorrecttothebestofmyknowledgeand
belief.
3.IntheeventofanyinformationbeingfoundfalseorincorrectorineligibilitybeingdetectbeforeorafterSelection,thecommissioncantake
actionagainstmeasperruleincaseitisdetectedthatIhavemisledUPSSSConanyissuethenIwillsolelyresponsibleforallpenel
consequencesthereof.

Currentstatusofapplication
Yourapplicationisunderprocessing.
ApplicationFormSubmissionDate: 04/10/2016,Time:11:40:23AM
ApplicationFormprintingDate&Time:[04/10/2016,11:34:50AM]

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