Application Form

Social Welfare Department (ICDS), Govt. of Bihar

Application for Contractual Recruitment of Lady Supervisor
Application Details
Application ID :     LSP/0546951 Application Date :
Post Applied For : Lady Supervisor
05-Aug-2019

Personal Details
Applicant Name VIBHAWARI MANI
Father's /Husband's Name RAMJI MANI
Mother's Name Radhika devi
Date of Birth 12-Aug-1996
Age as on (01.01.2019) 22 Years 4 Months
Gender Female
Marital Status Yes
Category EWS
Nationality Indian
Physically Handicapped No
Catagory of Physically Handicapped
Percentage of Physically No
Handicapped
Grand Children of Freedom Fighter No
Email ID nimmymishra679@gmail.com
Mobile No. 7485830301
Phone With STD Code
Aadhar No XXXXXXXX6153
Identification Marks Mole in right eye
Do you know read/write hindi Yes
Do you have minimum qualification Yes
as defined in Advertiesment
Reference of known person with Raghav Mishra
address who has seen Your Work
[Last Six Month] (1)
Reference of known person with Baherwa Mahuavan kateya gopalganj
address who has seen Your Work
[Last Six Month] (2)
If any Criminal No
Proceedings[Aapradhik Mukadama]
Against You has been Initiated ?
Are you Employee of Bihar No
Govenment
Designation
Office
Place

Address for Correspondence

Address Baherwa Mahuavan kateya gopalganj
Pin Code 841437

Permanent Address
Address Baherwa Mahuavan kateya gopalganj
 Pin Code 841437
State of Domicile Yes
Home District GOPALGANJ

Educational Qualification
  Board/University Institute State Specialization Passing Marks
Type Year Obtained
 (%)
I.Matric UPMSSP Gevernment Uttar 2011 69.6
LUCKNONOW Pradesh
II.Intermediate UPMSSP LUCK Gevernment Uttar Arts 2013 68.88
Pradesh
III.Degree SSVV Gevernment Uttar Graduate in Any Stream 2017 73.86
Pradesh
IV.Post SSVV Gevernment Uttranchal Post Graduate in Any 2019 76.33
Graduation Stream

Experience
No Experience Mentioned

Points
Total Point   70.78

I declare that all the above information is correct to the best of my knowledge and that I shall be liable for punishment if information
is found incorrect. I also declare that I have understood the guideline for engagement and will fully abide by the same including any
further guideline issued by ICDS, Government of Bihar in this regard. I categorically declare that there is no pending Criminal case or
serious complaint against myself.

Place:-

Date:-
Signature of Applicant