Direct Recruitment Chargeman APPLICATION FORM Registration No. : 14IT103843 Registration Date & Time : 21-07-2014 20:25:21 Trade : Information Technology Center Choice 1 : Chennai Center Choice 2 : Medak (near Hyderabad) Unit Choice 1 Unit Choice 2 Unit Choice 3 Ordnance Factory Tiruchirapalli Heavy Vehicle Factory Ordnance Factory Kanpur Applicant's Name : (First Name) (Middle Name) (Last Name) GAJULA LOVA KRISHNA Father's Name : VENKATA RAMA RAO Mother's Name : VENKATA SUVARNAKSHI Spouse's Name : Date of Birth : 12-05-1993 Gender : Male Nationality : Indian Category : UR Whether Departmental Candidate : No Whether Ex-Servicemen : No Physically Handicapped : No Candidates who had ordinarily been domiciled in the State of Jammu & Kashmir during period from 1st Jan 1980 to 31st Dec 1989 : No Whether belong to Minority Community : No Medium of Examination : English Educational Qualification (General) : Educational Qualification School / Inst. Year of Passing SSLC/10th BOARD OF SECONDARY EDUCATION ANDHRA PRADESH 2008 HSC/12th BOARD OF INTERMEDIATE HYDERABAD 2010 Technical/Non Technical Qualification (General) : Qualification Trade/Discipline Institutions Year of Passing B.Sc Degree Computer Science ANDHRA UNIVERSITY,VISAKHAPATNAM 2013 Page 1 of 2 Address For Correspondence City/Town/Village District State Tel No. : : : : : : : : GAJULA LOVA KRISHNA S/O VENKATA RAMA RAO D.NO. 28-67/1, 7TH WARD, KAPU STREET, NARSIPATNAM POST AND MANDAL NARSIPATNAM VISAKHAPATNAM ANDHRA PRADESH - 531116 - Email ID : lovakrishnagajula18@gmail.com Mobile No. : 9985001101 Nearest Railway Station : TUNI Payment Details : Bank Name Branch Code Challan No. Deposit Date Deposit Amount STATE BANK OF INDIA 00886 030714373 22-07-2014 100 Declaration : 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 commision. I have read the provisions in the Notice of the examination carefully and i hereby undertake to abide by them. I further declare that I fulfill all the conditions of eligibility regarding age limits, educational qualifications, and technical qualifications etc., prescribed for admission to the examination. I understand that in the event of ineligibility being detected at any point (before or after the examination), may candidature/appointment is liable to be cancelled. I also declare that I do not stand debarred by any of the Ordance Factories 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 dismissed or removed from Govt. Service or my service been terminated during probation. For all Candidates: 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 ot ineligibility being detected before or after the examination, my candidature/appointment is liable to be cancelled. Pl ease Paste your Col or Photograph 3.5 x 3.5 cm not ol der than 3 months. Registration No. : ______14IT103843________ Name : _________________________ Date : _________________________ Place : _________________________ ________________________________________________ Signature of the Candidate Note To Candidates : * Pl ease keep one photocopy of the Acknowl edgement Sl i p for future reference. * UR/OBC Candi dates, who are el i gi bl e to pay fees MUST ENCLOSE Ori gi nal Bank PAY IN SLIP al ongwi th the Regi strati on Sl i p dul y si gned and Photo affi xed. * The Envel ope must be sent by Ordi nary Post to the bel ow address. * Do not write 'Indian Ordnance Factories' in the Postal Address. Post Box No. 2091 Chennai 600020. Page 2 of 2 Back Print Logout