STAFF SELECTION COMMISSION
BLOCK NO. 12, CGO-COMPLEX, LODHI ROAD, NEW DELHI
110003
JUNIOR ENGINEER (CIVIL, MECHANICAL,
ELECTRICAL AND QUANTITY SURVEYING &
CONTRACTS) EXAMINATION, 2023
REGISTRATION NO: 83000318157
APPLICATION IS INCOMPLETE
1. NAME AS PER MATRICULATION 2. NEW/ CHANGED
3. FATHER'S NAME 4. MOTHER'S NAME
CERTIFICATE NAME
SANJAY KUMAR - PARAS NATH JAYANTREE DEVI
6. AGE AS ON
5. DATE OF BIRTH (DD/MM/YYYY) 7. GENDER 8. CATEGORY
01/08/2023
01/07/1994 29.1 MALE OBC
9. WHETHER PERSON WITH DISABILITY (PWD) ? 9.1 IF YES, TYPE OF DISABILITY (OH, HH,VH, OTHERS)
NO -
10. NATIONALITY 11. MARK OF VISIBLE IDENTIFICATION
CITIZEN OF INDIA A MOLE ON LEFT OF FACE
13. MATRICULATION (10th 14. MATRICULATION (10th
12. MATRICULATION (10th CLASS) EXAMINATION BOARD
CLASS) ROLL NO CLASS) YEAR OF PASSING
BOARD OF HIGH SCHOOL AND INTERMEDIATE
2934768 2009
EDUCATION UTTAR PRADESH
15. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER
(FIRST PREFERENCE) (SECOND PREFERENCE) (THIRD PREFERENCE)
AHMEDABAD ( 7001 ) MEHSANA ( 7013 ) ANAND ( 7011 )
16.1. WHETHER YOU ARE AN EX- 16.2. DATE OF JOINING THE ARMED 16.3. DATE OF DISCHARGE/ LIKELY DATE OF
SERVICEMAN (ESM) OR SERVING FORCES (DD/MM/YYYY) DISCHARGE FROM ARMED FORCES (DD/MM/
IN THE ARMED FORCES? YYYY)
NO - -
16.5. HAVE YOU ALREADY JOINED A
16.4. LENGTH OF SERVICE IN THE CIVIL POST BY AVAILING BENEFIT 16.6. DATE OF JOINING TO CIVIL POST
ARMED FORCES OF RESERVATION FOR EX- (DD/MM/YYYY)
SERVICEMAN (ESM) ?
- - -
17. WHETHER SUFFERING FROM CEREBRAL PALSY ?
-
17. 1 ARE YOU A PERSON WITH BENCHMARK DISABILITIES (40% OR MORE) IN THE CATEGORY OF BLINDNESS (VH)?
17.2 ARE YOU A PERSON WITH BENCHMARK DISABILITIES (40% OR MORE) IN THE CATEGORY OF OHBOTH ARMS AFFECTED
(OH-BA) OR OI-I- CEREBRAL PALSY (OH-CP)?
17.3 DO YOU HAVE A PHYSICAL LIMITATION TO WRITE AS PER PARA 9.2 OR 9.3 OF THE NOTICE (CERTIFICATE TO THIS EFFECT
FROM COMPETENT AUTHORITY AS PER FORMAT AT ANNEXURE-I/ ANNEXURE-IA TO THE NOTICE OF EXAMINATION, WOULD
BE REQUIRED AT THE TIME OF EXAMINATION.)?
17.4 WHETHER SCRIBE IS REQUIRED ? 17.5 WILL YOU MAKE YOUR OWN 17.6 IF SCRIBE IS TO BE ARRANGED BY
ARRANGEMENT OF SCRIBE ? SSC, INDICATE MEDIUM
- - -
18.1. WHETHER SEEKING AGE RELAXATION ? 18.2. IF YES, AGE RELAXATION CODE
NO -
19. POST(S) APPLYING FOR
JE- ELECTRICAL ENGINEERING
20. QUALIFICATION DETAILS
EXP(MIN. 2
QUALIFYING DIPLOMA/ DEGREE SUBJECT/ STREAM
YEARS)
DIPLOMA IN 3 YEARS(51) ELECTRICAL ENGINEERING 0
STATE/ UT OF
PASSING NAME OF BOARD/ PERCENTA
STATUS BOARD/ ROLL NO CGPA
YEAR UNIVERSITY GE
UNIVERSITY
BOARD OF
UTTAR
PASSED 2017 TECHNICAL 167289976217 71.09 -
PRADESH
EDUCATION, U.P
20.1 HIGHEST EDUCATIONAL QUALIFICATION
21. DO YOU WANT TO MAKE AVAILABLE YOUR PERSONAL INFORMATION FOR ACCESSING JOB
OPPORTUNITY IN TERMS OF DoP&T'S O.M NO.39020/1/2016-ESTT.(B) DATED 21.06.2016 ?
NO
ADDRESS DETAIL
22. CORRESPONDENCE ADDRESS 23. PERMANENT ADDRESS
VILLAGE SHAYAD KHANPUR POST KATARIYA VILLAGE SHAYAD KHANPUR POST KATARIYA
DISTRICT: GHAZIPUR DISTRICT:GHAZIPUR
STATE: UTTAR PRADESH STATE: UTTAR PRADESH
PIN : 233301 PIN : 233301
MOBILE NO: 9721316232 EMAIL: bsanjaybs025@[Link]
24. CONTACT FOR OTHER NATIONALS
25. WHETHER THE PHOTOGRAPH HAS BEEN TAKEN ON OR AFTER 27-APR-2023?
YES
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
NOT EXEMPTED 100 - -
DECLARATION
1. I HAVE READ THE NOTICE OF THE EXAMINATION AND ACCEPT ALL THE TERMS & CONDITIONS OF THE
NOTICE OF THE EXAMINATION.
2. 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, MY CANDIDATURE/ APPOINTMENT IS LIABLE TO BE CANCELLED.I
AM WILLING TO SERVE ANYWHERE IN INDIA.
3. I DECLARE THAT THE PHOTOGRAPH UPLOADED IN THE APPLICATION FORM HAS BEEN TAKEN ON OR
AFTER THE STIPULATED DATED.
4.I AGREE TO AUTHORIZE SSC TO USE MY AADHAAR DATA FOR VERIFICATION PURPOSE.
PRINT TAKEN ON: 16/08/2023 [Link] AM IP ADDRESS:[Link]
NUMBER OF ATTEMPT: 1
