Scribd
Upload
63 views3 pages

Application Form Draft Print For All

The document is an incomplete application form for the Combined Higher Secondary Level Examination 2022 conducted by the Staff Selection Commission. It contains details such as the applicant's name, father's name, date of birth, gender, category, educational qualifications, preferences for examination centers, photograph details, and a declaration signed by the applicant. However, it is marked as incomplete as the applicant has not paid the application fee.

Uploaded by

Kallem Satishreddy
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
63 views3 pages

Application Form Draft Print For All

The document is an incomplete application form for the Combined Higher Secondary Level Examination 2022 conducted by the Staff Selection Commission. It contains details such as the applicant's name, father's name, date of birth, gender, category, educational qualifications, preferences for examination centers, photograph details, and a declaration signed by the applicant. However, it is marked as incomplete as the applicant has not paid the application fee.

Uploaded by

Kallem Satishreddy
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
You are on page 1/ 3

STAFF SELECTION COMMISSION

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


110003
COMBINED HIGHER SECONDARY (10+2) LEVEL
EXAMINATION, 2022

REGISTRATION NO: 10003673896

APPLICATION IS INCOMPLETE

1. NAME AS PER MATRICULATION 2. NEW/ CHANGED NA 3. FATHER'S NAME 4. MOTHER'S NAME


SAJJAPOOR NIKHIL REDDY - SAJJAPOOR BICHI REDDY SAJJAPOOR PRABHAVATHI
5. DATE OF BIRTH (DD/MM/YYYY) 6. AGE AS ON 01/01/2022 7. GENDER 8. CATEGORY
21/10/2000 21.2 MALE UNRESERVED
9. WHETHER PERSON WITH DISABILITY (PwBD) ? 9.1 IF YES, TYPE OF DISABILITY (OH, HH,VH, OTHERS)

NO -

10. NATIONALITY 11. MARK OF VISIBLE IDENTIFICATION


CITIZEN OF INDIA A MOLE ON THE NECK
13. MATRICULATION (10th 14. MATRICULATION (10th
12. MATRICULATION (10th CLASS) EXAMINATION BOARD
CLASS) ROLL NO CLASS) YEAR OF PASSING
BOARD OF SECONDARY EDUCATION TELANGANA 1816113778 2018
15. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTRE EXAMINATION CENTRE EXAMINATION CENTRE
(FIRST PREFERENCE ) (SECOND PREFERENCE ) (THIRD PREFERENCE)
HYDERABAD ( 8601 ) KARIMNAGAR ( 8604 ) WARANGAL ( 8603 )
17. WHETHER 12TH STANDARD PASS IN SCIENCE STREAM WITH
16. MEDIUM FOR TYPING TEST: MATHEMATICS AS A SUBJECT FROM A RECOGNIZED BOARD OR EQUIVALENT
(FOR C&AG AS DATA ENTRY OPERATOR):
ENGLISH YES
18.1. WHETHER YOU ARE AN EX- 18.2. DATE OF JOINING THE ARMED 18.3.DATE OF DISCHARGE/ LIKELY
SERVICEMAN (ESM) OR SERVING IN FORCES (DD/MM/YYYY) DATE OF DISCHARGE FROM ARMED
THE ARMED FORCES? FORCES (DD/MM/ YYYY)

NO - -
18.4. LENGTH OF SERVICE IN THE 18.5. HAVE YOU ALREADY JOINED A 18.6. DATE OF JOINING TO CIVIL POST
ARMED FORCES CIVIL POST BY AVAILING BENEFIT OF (DD/MM/YYYY)
RESERVATION FOR EX-SERVICEMAN
(ESM) ?
- - -
19.1.ARE YOU A PERSON WITH BENCHMARK DISABILITIES (i.e. 40% OR MORE) IN THE CATEGORY OF BLINDNESS,
BOTH ARMS AFFECTED- BA AND/ OR CEREBRAL PALSY ?
-
19.2. 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) ?
-
19.3. WHETHER SCRIBE IS REQUIRED ? 19.4. WILL YOU MAKE YOUR OWN 19.5. IF SCRIBE IS TO BE ARRANGED
ARRANGEMENT OF SCRIBE ? BY SSC, INDICATE MEDIUM
- - -

20.1. WHETHER SEEKING AGE RELAXATION ? 20.2. IF YES, AGE RELAXATION CODE

NO
-
21. HIGHEST EDUCATIONAL QUALIFICATION
INTERMEDIATE/ HIGHER SECONDARY/ 10+2 (2)
22. DETAILS OF QUALIFYING EDUCATIONAL QUALIFICATION
12TH STANDARD
STATE/ UT OF NAME OF BOARD/
STATUS PASSING YEAR ROLL NO PERCENTAGE CGPA
BOARD/ UNIVERSITY UNIVERSITY
TELANGANA
BOARD OF
PASSED 2020 TELANGANA 2049212031 41 -
INTERMEDIATE
EDUCATION.
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. CORRESPONDENCE ADDRESS 25. PERMANENT ADDRESS
H NO 4-5-19 GADI STREET ZAHEERABAD H NO 4-5-19 GADI STREET ZAHEERABAD

DISTRICT: SANGAREDDY DISTRICT:SANGAREDDY


STATE: TELANGANA STATE: TELANGANA
PIN : 502220 PIN : 502220
MOBILE NO: 9398666357 EMAIL: nikhilreddy0908@gmail.com
27. WHETHER THE PHOTOGRAPH HAS BEEN TAKEN ON OR AFTER 06-SEPTEMBER-2022?
YES
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
NOT EXEMPTED 100 - -
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.

3. I DECLARE THAT THE PHOTOGRAPH UPLOADED IN THE APPLICATION FORM HAS BEEN TAKEN ON OR
AFTER THE STIPULATED DATED.

4. I AGREE TO AUTHORIZE SSC TO USE MY AADHAR DATA FOR VERIFICATION PURPOSE.


PRINT TAKEN ON: 02/01/2023 4:21:57 PM IP ADDRESS: 103.105.179.62

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy