Application Form

Panchayti Raj Department, Govt. of Bihar

Application for Recruitment
Application Details
Application ID :     TAT/0009034 Application Date : 02-Sep-2018 Post Applied For : Technical Assistant
Personal Details
Applicant Name : MD TAMREEN REZA
Father's /Husband's Name : MD YASEEN
Date of Birth : 04-Dec-1994
Age on (01.08.2018) : 23 Years 7 Months
Gender : Male
Category : GEN
Nationality : Indian
Email ID : mdtamreenreza@gmail.com
Mobile No. : XXXXXXX8904
Aadhar Type Aadhar No
Aadhar No XXXXXXXX1989
Phone With STD Code :
Physically Handicapped No
Grand Children of Freedom Fighter No

Address for Correspondence

Address : VILLAGE:-BAKHRI BUZURG, POST:-RUPAULI, P.S.:-MUSRIGHARARI, DIST:-
SAMASTIPUR BIHAR
Pin Code : 848132

Permanent Address
Address : VILLAGE:-BAKHRI BUZURG, POST:-RUPAULI, P.S.:-MUSRIGHARARI, DIST:-
SAMASTIPUR BIHAR
Pin Code : 848132
State of Domicile : Bihar
Home District : SAMASTIPUR
Choice District : SAMASTIPUR

Educational Qualification
  Board/University Specialization State Whether Passing Marks Full Marks Marks
Government or Year Obtained (Excluding Obtained
Private (Excluding Extra  (%)
Extra Subject)
Subject)
I.Matric CBSE Delhi Government 2009 295 500 59
II.Intermediate/12th 0 0 0 0
IV.Diploma ALIGARH Diploma in Uttar Government 2013 4166 6000 69.43
MUSLIM Civil Pradesh
UNIVERSITY Engineering
V.Additional BACHELOR OF CIVIL Uttar Government 2018 65 100 65
Qualification ENGINEERING Pradesh

I declare that all the above information is correct to the best of my knowledge and that I shall be liable for punishment if
any information is found incorrect. I also declare that I have understood the guideline for engagement and will fully abide
by the same including any future guideline issued by Panchayti Raj Department in this regard.

Place:-

Date:-
Signature of Applicant