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ON-LINE APPLICATION FOR RECRUITMENT OF SOCIAL SECURITY ASSISTANT

21028

Registration # : Full name: Category :

1149060 SWATI CHAUDHARY GENERAL

Are you an Employee of Central Government or Employees' Provident Fund Organization ? : NO Quota : If physically Challenged : Type of Disability : Category of Disablement : Percentage of disability : Do you intend to use the services of a scribe? : Are you an Ex - Serviceman ? : Period of Service as an Ex-Serviceman (in months) : Nationality : Name of Region : Examination Centre : Centre code : Application Fee / Postal Charges Details : Payment IN : Journal No : Branch Name : Branch Code number : Deposit Date : Amount : Personal Details : Date of Birth : Age completed(as on 09.03.2012) : Gender : Father's Name / Husband's Name : Mother's name : Address for Correspondence : 30-06-1990 21 FEMALE ANKUSH CHAUDHARY ANITA CHAUDHARY ROOM NO-63 SHREE SHANTA NAGARAM BANASTHALI VIDYAPEETH BANASTHALI District : State : Pin : Permanent Address : TONK RAJASTHAN 304022 NEW ARYA PURAM OPP. TALWAR PETROL PUMP MAWANA ROAD District : State : MEERUT UTTAR PRADESH State Bank of India 006475746 BANASTHALI 15363 05-03-2012 315 None NO NA NO -INDIAN Delhi Delhi 15

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Pin : 250001

Contact Details: Email ID : Phone No : Mobile No: Qualification Details (as on 09.03.2012): Exam Passed Graduation/Equivalent : Working Knowledge of Computers : Details of Computer Knowledge : Post Qualification Work experience details (Start from present Employer) : Name of the Employer Designation From(mm/yyyy) To(mm/yyyy) Nature of Duties Performed Reason for Leaving Length of Service (YY/MM) Name of the Course/Degree BCA Year of Passing 30-06-2009 YES I know microsoft office % of Marks 73.00 Class / Grade First Class 0123swati@gmail.com 9509210598

Total Experience (in months) :

DECLARATION:
I hereby declare that i. I declare that I fulfill all the conditions of eligibility regarding age limits, educational qualifications etc, prescribed for admission to the examination for the quota / category under which I have applied. ii. All the statements made in this application are true , correct and complete to the best of my knowledge and belief, and if any of the particulars furnished by me are found to be incorrect or suppressed, or my ineligibility being detected before or after the examination, my candidature is liable to be rejected at any stage of the selection process. Even if it is found after my appointment in EPFO that the particulars furnished by me were incorrect , false, incomplete or suppressed, my services would be liable to be terminated without any notice. iii. I also declare that I do not stand debarred by any organisation under the Government of India as on date and have never been convicted by any court of law. I also declare that no charge sheet is pending against me in any court of law. Further declare that I have never been dismissed or removed from Govt Service or my service been terminated during probation. iv. I agree that my final appointment shall be subject to my fulfilling all the conditions / eligibility criteria as per rules applicable for the category / quota under which I have applied. v. For Candidate belonging to Ex-Serviceman I declare that I fulfill all the eligibility conditions relating to EX-Serviceman as per rules existing in this regard. vi. For candidates belonging to Sports Quota I declare that I fulfill all the eligibility conditions relating to recruitment of meritorious Sports persons as per advertisement / rules existing in this regard. vii. In case of my selection I am willing to serve anywhere in India.

Place: Date: 05-03-2012 Signature of Applicant

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