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Staff Selection Commission: Multi Tasking Staff (MTS) Examination 2019

1. The document is an application form for the Multi Tasking Staff (MTS) Examination 2019 from the Staff Selection Commission of India. 2. It contains the personal details of the applicant, Shubham Kumar Tiwari, such as his name, father's name, date of birth, category, address, educational qualifications, and preference of examination centers. 3. The applicant has declared that all statements made in the application are true and correct, and he is willing to serve anywhere in India if selected.

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35 views2 pages

Staff Selection Commission: Multi Tasking Staff (MTS) Examination 2019

1. The document is an application form for the Multi Tasking Staff (MTS) Examination 2019 from the Staff Selection Commission of India. 2. It contains the personal details of the applicant, Shubham Kumar Tiwari, such as his name, father's name, date of birth, category, address, educational qualifications, and preference of examination centers. 3. The applicant has declared that all statements made in the application are true and correct, and he is willing to serve anywhere in India if selected.

Uploaded by

Generic HaKarism
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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STAFF SELECTION COMMISSION

BLOCK NO. 12, CGO COMPLEX, LODHI ROAD, NEW DELHI


110003

MULTI TASKING STAFF (MTS) EXAMINATION 2019

REGISTRATION NO: 85000035615

APPLICATION IS PROVISIONALLY ACCEPTED


1. NAME AS PER 2. NEW/CHANGED
MATRICULATION 3. FATHER'S NAME 4. MOTHER'S NAME
NAME
CERTIFICATE
SHUBHAM KUMAR TIWARI - SHRI NIWAS TIWARI PRAMILA TIWARI
5. DATE OF BIRTH (DD/MM/YYYY) 6. AGE AS ON 01/08/2019 7. GENDER
06/10/1998 20.9 MALE
8. CATEGORY 9. ID NUMBER 10. NATIONALITY
UR 87XXXXXXXX53 CITIZEN OF INDIA
11. MARK OF VISIBLE IDENTIFICATION : MOLE SIGN ON FACE
12. MATRICULATION (10th CLASS) EXAMINATION 13. MATRICULATION (10th 14. MATRICULATION (10th
BOARD CLASS) ROLL NO CLASS) YEAR OF PASSING
MADHYA PRADESH BOARD OF SECONDARY
153238419 2015
EDUCATION
15. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER ( FIRST ) EXAMINATION CENTER ( SECOND ) EXAMINATION CENTER ( THIRD )

6014 - SATNA 6007 - JABALPUR 6001 - BHOPAL


16.1. HAVE YOU ALREADY
JOINED A CIVIL POST BY 16.3. DATE OF DISCHARGE
16.WHETHER EX- 16.2. LENGTH OF SERVICE IN
AVAILING BENEFIT OF FROM ARMED FORCES
SERVICEMAN (ESM)? ARMED FORCES ( IN YEARS )
RESERVATION FOR EX- (DD/MM/YYYY)
SERVICEMAN (ESM) :?
NO - - -
17. WHETHER PERSON WITH DISABILITY 17.1 IF YES, TYPE OF DISABILITY (OH, HH,VH, OTHERS)
(PWD) ?
NO -
18.1 WHETHER SUFFERING FROM CEREBRAL PALSY
-
18.2 DO YOU HAVE A PHYSICAL LIMITATION TO WRITE AND SCRIBE IS REQUIRED TO WRITE ON YOUR BEHALF
(CERTIFICATE TO THIS EFFECT FROM THE CHIEF MEDICAL OFFICER/ CIVIL SURGEON & MEDICAL
SUPERINTENDENT OF A GOVERNMENT HEALTH CARE INSTITUTION AS PER NOTICE OF THE EXAMINATION
WOULD BE REQUIRED AT THE TIME OF EXAMINATION)?
-
18.3 WHETHER SCRIBE IS REQUIRED 18.4 WILL YOU MAKE YOUR OWN 18.5 IF SCRIBE IS TO BE
ARRANGEMENT OF SCRIBE? ARRANGED BY SSC, INDICATE
MEDIUM
- - -
19. WHETHER SEEKING AGE RELAXATION? 19.1 IF YES,INDICATE CODE
NO -
20. STATE(S) / U.T. PREFRENCE CODE
Y,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X
21. EDUCATIONAL QUALIFICATION
INTERMEDIATE/ HIGHER SECONDARY/ 10+2
22. DO YOU BELONG TO ECONOMICALLY WEAKER SECTIONS (EWS) ?
YES
23. DO YOU WANT TO MAKE AVAILABLE YOUR PERSONAL INFORMATION FOR ACCESSING JOB OPPORTUNITY IN
TERMS OF DoP&T'S O.M NO.39020/1/2016-ESTT.(B) DATED 21.06.2016 ?
YES
ADDRESS DETAIL
24. POSTAL ADDRESS 25. PERMANENT ADDRESS
MAKAN NO 80/1 WARD NO 16 NEAR SCHOOL JHARI MAKAN NO 80/1 WARD NO 16 NEAR SCHOOL JHARI
PANTI HANUMANA REWA PANTI HANUMANA REWA
DISTRICT: REWA DISTRICT: REWA
STATE: MADHYA PRADESH STATE: MADHYA PRADESH
PIN: 486335 PIN: 486335
MOBILE NO. : 9340798494 EMAIL ID: shubhamktiwari68@gmail.com
SIGNATURE

FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE


NOT EXEMPTED 100 CPS3568517 22/05/2019
DECLARATION
1. I HAVE READ THE NOTICE OF THE EXAMINATION AND ACCEPT ALL THE TERMS & CONDITIONS OF
THE NOTICE OF THE EXAMINATION.

2. I HEREBY DECLARE THAT ALL STATEMENTS MADE IN THIS APPLICATION ARE TRUE, COMPLETE
AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT IN THE EVENT OF
ANY INFORMATION BEING FOUND SUPPRESSED/FALSE OR INCORRECT OR INELIGIBILITY BEING
DETECTED BEFORE OR AFTER THE EXAMINATION, MY CANDIDATURE/ APPOINTMENT IS LIABLE TO BE
CANCELLED.I AM WILLING TO SERVE ANYWHERE IN INDIA.
PRINT TAKEN ON: 22/05/2019 10:44:02 AM

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