Application Form

Panchayti Raj Department, Govt. of Bihar

Application for Recruitment
Application Details
Application ID :     TAT/0003999 Application Date : 30-Aug-2018 Post Applied For : Technical Assistant
Personal Details
Applicant Name : MD SHAHJAHAN
Father's /Husband's Name : MD JAHANGEER
Date of Birth : 10-Mar-1997
Age on (01.08.2018) : 21 Years 4 Months
Gender : Male
Category : GEN
Nationality : Indian
Email ID : mdshahjahan824@gmail.com
Mobile No. : XXXXXXX4286
Aadhar Type Aadhar No
Aadhar No XXXXXXXX9502
Phone With STD Code :
Physically Handicapped No
Grand Children of Freedom Fighter No

Address for Correspondence

Address : Ward 12, V+P chandauli, samastipur, bihar
Pin Code : 848115

Permanent Address
Address : Ward 12, V+P chandauli, samastipur, bihar
Pin Code : 848115
State of Domicile : Bihar
Home District : SAMASTIPUR
Choice District : SAMASTIPUR

Educational Qualification
  Board/University Specialization State Whether Passing Marks Full Marks Marks
Government Year Obtained (Excluding Obtained
or Private (Excluding Extra  (%)
Extra Subject)
Subject)
I.Matric BIHAR SCHOOL Bihar Government 2013 290 500 58
EXAMINATION BORD
II.Intermediate/12th 0 0 0 0
IV.Diploma MAULANA AZAD Diploma in Karnataka Government 2017 3559 5300 67.15
NATIONAL URDU Civil
UNIVERSITY Engineering
V.Additional 0 0 0 0
Qualification

I declare that all the above information is correct to the best of my knowledge and that I shall be liable for punishment if
any information is found incorrect. I also declare that I have understood the guideline for engagement and will fully abide
by the same including any future guideline issued by Panchayti Raj Department in this regard.

Place:-

Date:-
Signature of Applicant