SSC Online Examination Form - Verification & Declaration

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Application Form For Multi Tasking (Non-Technical) Staff - 2014

VERIFY YOUR APPLICATION DETAILS Examination Applied Year State/UT of Domicile Name of the Centre & Code Name Father's Name Mother's Name Date of Birth Age as on normal closing date (2014-01-01) Gender Nationality Fee Exemption Claimed Category Whether Ex-Serviceman Physically Handicapped Whether Cerebral Palsy Claiming age relaxation Whether belong to Minority Community : Multi Tasking (Non-Technical) Staff 2014 West Bengal(5) ER - Kolkata(4410) YOGESH GHOSH SUSHIL KR GHOSH PURNIMA GHOSH 10-07-1991 22 Years 5 Months 22 Days Male Indian No General No No No No No

Postal Address Address Line 1 Address Line 2 Address Line 3 District / City State / UT Pincode Phone Mobile E-Mail I.G.W.T.P. Gate-1, Qtr No-B/15 Near CIFRI (Fishery Office) Monirampore, Barrackpore Barrackpore West Bengal 700120 033 65633135 9038287438 yogesh.ghosh2012@gmail.com

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08-12-13

SSC Online Examination Form - Verification & Declaration

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Language for Paper II Educational Qualification Matriculation Intermediate/Higher Secondary Name of the Organisation(s) Others Physics

ENGLISH Subject % of Marks 74.5 61.0 Medium Others Others

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Declaration

1. Registration id shall be valid till 5pm of closing date. 2. I have not submitted any other applications for this examination. I am aware that if I contravene this rule, my application will be rejected summarily by the commission. 3. I have read the provisions in the Notice of the examination carefully and I hereby undertake to abide by them. 4. I further declare that I fulfill all the conditions of eligibility regarding age limits, educational qualifications etc., prescribed for admission to the examination. 5. I also declare that I do not stand debarred by SSC/UPSC 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 desmissed or removed from Govt. Service or my service been terminated during probation. 6. For Central Govt. Civilian Employee seeking age relaxation. I declare that I am a Central Govt. Civilian Employee and completed 3 years regular service or regular length of service stipulated in the Notice of the examination on or before date of closing of submitting application form given in the Notice. 7. For Candidate belonging to OBC I declare that I belong to the community which is recognized as a backward class by Govt. of India for the purpose of reservation in service as per orders contained in Deptt. of Personnel and Training office memorandum No. 36012/22/93- Esst. (SCT) dated 8.9.1993. I also declare that I do not belong to the person/sections (creamy layer) mentioned in column 3 of the schedule of the OM mentioned above and modified vide Govt. of India DOPT OMs mentioned in the notice. I further declare that I am in possession of OBC Certificate in the prescribed format given in the Notice of the examination and .

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08-12-13

SSC Online Examination Form - Verification & Declaration

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8. For Candidate belonging Ex-Serviceman I declare that I fulfill all the eligibility condition relating to Ex-Serviceman as per notice of exam and I have not availed employment in civil side under Central Government as Ex-servicemen. 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, may candidature/appointment is liable to be cancelled.

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http://ssconline.nic.in/form4.php

08-12-13