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1.RecruitmentDetails
RecruitmentName RecruitmentforJEN(CIVILANDMECHANICAL)2016
PostApplied JENNonScheduled
ApplicaonNo. 201600067874
ApplicaonSubmiedDate 14Jul201612:16:07AM
2.Applicant'sDetails
No.OfLivingChild(Bornbefore01/06/2002) Bhamashah NA 0
0 0
ApplyingFor
Applyingfor JENCivilDegree
CorrespondanceAddress
NEAROLDAGEHOME,NAINWA
AddressLine1 PLOTNO71,KUNJVIHARCOLONY AddressLine2 ROAD
PermanentAddress
NEAROLDAGEHOME,NAINWA
AddressLine1 PLOTNO71,KUNJVIHARCOLONY AddressLine2 ROAD
Village NA SeledinIndiafromOtherCountry No
FromWhichCountry NA
SpecialCategory
AreYouExprisoner? No TimeofPrisonment(Inmonths) NA
AreyouNCCCadetinstructor? No Duraon(Inmonths) NA
AreYouExServiceman? No DepartmentName NA
OutstandingSportsPersons? No SportPersonType NA
ExisngGovtDept/PubicUndertaking
Employee? No DepartmentName NA
ExisngStateGovernmentEmployee
(Substanve)? No DepartmentName NA
4.EducaonQualicaonDetails
Nameof Yearof
SNo. NameofExam RollNo. Result Percentage/Grade
Board/University/School Passing
1 Secondary RBSE 0192436 2007 Percentage 72.33
2 Secondary RBSE 0192436 2007 Percentage 72.33
3 Sr.Secondary/Equivalent RBSE 1164531 2009 Percentage 79.08
4 Sr.Secondary/Equivalent RBSE 1164531 2009 Percentage 79.08
5 BE/B.tech MPUAT 3512 2014 CGPA 7.38
6 BE/B.tech MPUAT 3512 2014 CGPA 7.38
Debarrded
HasanyBoard/CommisionDebarredyouforuseofunfairmeansetcinit'sCompetve/RecruitmentExam? No
NameofBoard/Commision NA OrderNumber NA
OrderDate NA NameOfExam NA
PeriodForWhichdebarred(In
ExamDate NA Months) NA
Hastheperiodofdebarofexpired? No
5.FeeStatus
FeeSubmied
TransaconDate 14Jul201612:16:07AM
6.Declaraon
6.Declaraon
Iherebydeclarethatallinformaongiveninthisapplicaonformaretrueandcorrecttothebestofmyknowledgeandbelief.Informaonlike
Namefathernamemothernamehusbandnamedateofbirthcategoryphotosignaturemobilenumberetc.hasbeenveriedandIamcompletely
sasedbytheselleddetailsintheapplicaonform.Iwillberesponsibleincaseofanymistakefoundinmyapplicaonform.Intheeventofmy
informaonbeingfoundfalseorincorrectortheineligibilitybeingdetectbeforeora erthewrientestaconcanbetakenagainstmebythe
competentauthority.IhavereadtheprovisionsoftherelevantrulesandtheadversementcarefullyandIherebyundertaketoabidebythem.I
furtherdeclarethatIfulllallthecondionsofeligibilityregardingtheagelimitseducaonqualicaonetc.prescribedforadmissiontothewrien
test.
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KAPILKUMARGAUTAM