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Application Form

Panchayti Raj Department, Govt. of Bihar


Application for Recruitment
Application Details
Application ID :     TAT/0008048 Application Date : 01-Sep-2018 Post Applied For : Technical Assistant
Personal Details
Applicant Name : MUKESH KUMAR
Father's /Husband's Name : BABU RAM
Date of Birth : 24-Feb-1994
Age on (01.08.2018) : 24 Years 5 Months
Gender : Male
Category : GEN
Nationality : Indian
Email ID : mukeshchoudhary12397@gmail.com
Mobile No. : XXXXXXX7645
Aadhar Type Aadhar No
Aadhar No XXXXXXXX5839
Phone With STD Code : 9587647645
Physically Handicapped No
Grand Children of Freedom Fighter No

Address for Correspondence


Address : VILLAGE=AMARAPURA POST-BADGAON TEHSHIL-RANIWARA DISTRICT-JALORE
RAJASTHAN
Pin Code : 343048

Permanent Address
Address : VILLAGE=AMARAPURA POST-BADGAON TEHSHIL-RANIWARA DISTRICT-JALORE
RAJASTHAN
Pin Code : 343048
State of Domicile : Rajasthan
Home District : OTHER
Choice District : SAMASTIPUR

Educational Qualification
  Board/University Specialization State Whether Passing Marks Full Marks Marks
Government or Year Obtained (Excluding Obtained
Private (Excluding Extra  (%)
Extra Subject)
Subject)
I.Matric BSER AJMER Rajasthan Private 2010 392 600 65.33
II.Intermediate/12th BSE AJMERR Science Rajasthan Private 2012 259 500 51.8
IV.Diploma BTER JODHAPUR Diploma in Rajasthan Private 2015 2320 3410 68.04
Civil
Engineering
V.Additional RKCL KOTA COMPUTER Rajasthan Private 2016 68 100 68
Qualification COURS{RSCIT}

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

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