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Ministry of Home Affairs,Govt. of India

Post Applied For :
Personal Information: Applicant's Name: Father's /Mother's Name: Relationship: Category: FATHER GENERAL AJIT KUMAR JENA BIPINBIHARI JENA Gender: Religion: MALE HINDU Date Of Birth: Others Religion: 2/3/1990

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ACIO GRADE-II/EXECUTIVE

Applicant's Registration No :MHA300017934

Your Photo

Are you a Central Govt. Employee with 3 or more years of Continuous Service? : NO

Nationality: Are you an Ex-Serviceman?

INDIAN

State of Domicile: NO

ORISSA

Domicile of J&K during the period 01.01.1980 to 31.12.1989 : NO Qualification Details: Name of Graduation Degree: Month & year of Passing: College/Institute Name Name of University affiliated: Additional Qualification (if any) : Name of Qualification : POST GRADUATION Additional Information: Contact No. (Only Digits): Email ID: Choice of Examination Center: Address Line 1: Address Line 2: Address Line 3: City/Town: BHUBANESWAR PIN: 751006 State: ORISSA Home State to which candidate belong to: ORISSA Are you prepared to serve anywhere in India? YES Declaration I hereby declare that the the information given above is true and correct to the best of my knowledge and I fulfill the eligibility conditions for appearing in the recruitment test conducted by Ministry of Home Affairs(MHA) for the post of ACIO-II/Exe. I further declare that in case any of the above information is found to be false/incorrect or any ineligibility being detected before, during or after the test, my candidature for the post of ACIO-II/Exe is liable to be forfeited. 919090985484 Alternate Mobile No. (if any): BHUBANESHWAR PLOT NO 828P LAXMISAGAR 91 ajya.ajitkumarjena@gmail.com Alternate Email ID (optional): BA Month: JUNE Year: 2011 Duration of the Course: Division/Class of Passing: MAHARISHI COLLEGE UTKAL UNIVERSITY YES Details : PERSONNEL MANAGEMENT & INDUSTRIAL RELATION Years: 3 Months: 0 SECOND

Final Result Declared as on closing date: YES

(Applicant's Signature)

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