1/3

ON-LINE APPLICATION FOR TNPSC REGISTRATION

This online application is provisional subject to payment of application fees/ intimation charges

38026
Registration # : 401677841

Notification. No. :

01/2014

Full Name : One Time ID : Name of The Post Applying for : Are you a Destitute Widow? : Are you a Differently Abled Person? : Are you an Ex-Serviceman ? : PPO No : Date of Discharge / Probable date of Discharge : Are you a Government Employee? : Nationality / Citizenship : Application Fee / Intimation Charges details: Payment Mode: Amount : Personal Details : Date of Birth : Gender : Marital Status : Religion : Candidate's Place of Birth : Native District : Father's Name : Father's Place of Birth : Mother Tongue : Mother's Name : Communal Category : Name of the Sub Caste : Certificate No : Date Of Issue : Issuing Authority : Taluk : District : Address for Correspondence :

R MOHAN -Assistants in various departments NA NO NO --NO Indian

Post Office 50.00

11/03/1983 MALE UnMarried Hindu NEYVELI Cuddalore A RAMAKRISHANAN Cuddalore Tamil R ANBAZHAI Scheduled Caste (SC) AdiDravida 6539248 13/01/2011 Taluk Tahsildar Kurinjipadi Cuddalore 6/E HOSTEL TYPE BLOCK-10 NEYVELI TOWN SHIP

District State : Pin : Permanent Address :

Cuddalore Tamil Nadu 607801 A-27/29 EAST STREET VIZHAPPALAM KURINJIPADI

2/3
District State : Pin : Contact Details : Email ID : Mobile No : EDUCATIONAL QUALIFICATION PARTICULARS : Exam Passed Date of Publication of Results 30/05/2002 S.S.L.C : 12/05/2004 Tamil H.S.C PHARMACY Tamil N/A N/A Medium of Instruction N/A BOARD OF SCHOOL EXAM TN BOARD OF SCHOOL EXAM TN ANNAMALAI UNIVERSITY Degree Major Subject Board / University heyramneyveli@gmail.com 8438158880 Cuddalore Tamil Nadu 607302

H.S.C or Equivalent Qualification : Degree : Others :

30/08/2010

English

B.Pharm -No

Do you claim reservation for Persons Studied in Tamil Medium (PSTM)? : Details regarding the prescribed qualification : Qualification Details : Other Equivalent Qualification Details : Certificate No : Year of Passing : Name of the Authority/ University : Do you possess Special / Preferential qualification? : Physical Standards as per notification :

Any Degree -04501092 2010 ANNAMALAI UNIVERSITY No No English Type Writing Short hand -Cert. No. Issued by Dir. of Cert. No. Issued by Dir. Tamil Technical Education of Technical Education ----

Type writing / Short hand Qualification

--

--

--

--

Name of the Examination Centre District: Name of the Examination Centre : Optional Subject : Do you claim Age Concession? : Do You Claim Fee Exemption? : Criminal Case (Registered/Pending/Punishment awarded) : Participation in Political Activities (In agitation/As a Member of Political Organisation/Candidature in Election) : Post Qualification work experience (Start from present Employer) : Name of the Organisation Previous appearance for Oral Test / Written Test Name of the Post Designation

Cuddalore Neyveli General Studies (Degree Standard) with General Tamil (S.S.L.C Standard) No No Not Applicable Not Applicable

From(mm/yyyy)

To(mm/yyyy)

Nature of Duty

Register No.

Year

---

---

---

DECLARATION:
1. I hereby declare that all the particulars furnished in this application are true, correct and complete to the best of my knowledge and belief. In the event of any information being found false or incorrect or ineligibility being detected before or after the examination, action can be taken against me by the TNPSC.

3/3
2. I hereby declare that I will not be a party to any kind of canvassing on my behalf.

3. I further declare that I fulfil all the eligibility conditions prescribed for admission to the examination.

4. I have informed my employer in writing that I am applying for this Examination.

5. I have gone through the Instructions etc. to candidates and the Commissions notification for this Recruitment before filling up the application form.

6. I declare that I possess the medical standards prescribed for the post(s) which I am now applying.

7. I Certify that I have not been debarred / disqualified by the TNPSC or any other recruiting agency.

8. I am not a dismissed Government Employee.

I accept the above declaration

Place:

Date: 2014-03-05 18:24:50

Signature of Applicant

Please retain your Registration No. and Password emailed to you carefully for further reference