J&K SERVICES SELECTION BOARD
GOVERNMENT OF JAMMU & KASHMIR
APPLICANT ID: 117168628 APPLICATION DATE: 2020-07-21
APPLIED APPLICATION FORM FOR APPOINTMENT TO CLASS-IV
ADVERTISEMENT NUMBER - 01 OF 2020
PERSONAL DETAILS
APPLICANT NAME MR RAVINDER KUMAR GENDER MALE
FATHER'S NAME BODH RAJ MOTHER'S NAME GITA DEVI
DATE OF BIRTH 1992-02-14 AGE AS ON 01.01.2020 27
PHONE NUMBER 9622383393 EMAIL RAVISARMAL9622383393@GMAIL.COM
WHETHER MARRIED NO WHETHER DOMICILE YES
DOMICILE DIVISION JAMMU DOMICILE DISTRICT UDHAMPUR
WHETHER DOMICILE
NO DOMICILE CERTIFICATE NUMBER -
CERTIFICATE ISSUED?
DOMICILE CERTIFICATE ISSUE DOMICILE CERTIFICATE ISSUING
- -
DATE AUTHORITY
DOMICILE DISTRICT AS PER DOMICILE TEHSIL AS PER
- -
CERTIFICATE CERTIFICATE
CORRESPONDENCE ADDRESS
LOCALITY/MOHALLA/WARD
HOUSE NO./ROOM NO. R/O-JAGWAL AP JANSAL P/O-DUMMA
NUMBER
VILLAGE/TOWN/CITY UDHAMPUR PANCHAYAT
BLOCK MAJALTA TEHSIL MAJALTA
DISTRICT UDHAMPUR (JAMMU DIVISION) PINCODE 184205
PERMANENT ADDRESS
LOCALITY/MOHALLA/WARD
HOUSE NO./ROOM NO. R/O- JAGWAL AP JANSAL P/O-DUMMA
NUMBER
VILLAGE/TOWN/CITY UDHAMPUR PANCHAYAT
BLOCK MAJALTA TEHSIL MAJALTA
DISTRICT UDHAMPUR (JAMMU DIVISION) PINCODE 184205
CATEGORY OF APPLICANT
CATEGORY OM DATE OF ISSUE OF CATEGORY CERTIFICATE -
CATEGORY CERTIFICATE ISSUING AUTHORITY -
WHETHER YOU BELONG TO ANY SUCH SECTION / CATEGORY WHICH IS ELIGIBLE FOR
-
ADDITIONAL WEIGHTAGE IN TERMS OF S.O. 184 DATED 04-06-2020?
ARE YOU SPECIALLY ABLED PERSON (PH)? NO DISABILITY PERMANENT OR TEMPORARY? -
TYPE OF DISABILITY - PERCENTAGE OF DISABILITY -
DATE OF ISSUANCE OF PHYSICAL DISABILITY CERTIFICATE - ISSUING AUTHORITY -
ARE YOU AN EMPLOYEE OF J&K GOVERNMENT? NO CATEGORY -
DATE OF APPOINTMENT / ENGAGEMENT - SELECT DEPARTMENT -
OTHER DEPARTMENT - APPOINTING AUTHORITY -
ARE YOU AN EX-SERVICEMEN? NO DATE OF RETIREMENT/DISCHARGE -
PENSION PAYMENT ORDER (PPO) NUMBER - EX-SERVICEMEN CERTIFICATE NUMBER -
EX-SERVICEMEN CERTIFICATE ISSUE DATE -
PENDING CRIMINAL PROCEEDINGS, IF ANY
WHETHER ANY FIR HAS BEEN LODGED/REGISTERED AGAINST
NO FIR(S) DETAILS -
YOU?
WHETHER ANY PROSECUTION IS PENDING IN ANY COURT OF
NO
LAW AGAINST YOU?
WHETHER YOU HAVE BEEN CONVICTED BY ANY COURT OF WHETHER ANY PROSECUTION IS PENDING IN
NO -
COMPETENT JURISDICTION IN ANY OFFENCE? ANY COURT OF LAW AGAINST YOU?
WAS ANY COURT CASE BEEN FILED AGAINST YOU? NO DETAILS -
WHETHER ANY CHARGESHEET HAS BEEN FILED AGAINST YOU? NO DETAILS -
SECTION UNDER WHICH CHARGESHEET HAS
NATURE OF OFFENCE - -
BEEN FILED
WHETHER ANY DISCIPLINARY ACTION HAS BEEN INITIATED BY
GOVERNMENT/SEMI-GOVERNMENT ORGANISATIONS AGAINST NO DETAILS -
YOU?
QUALIFICATION DETAILS
WHETHER SSSC(12TH) QUALIFIED NO
JK STATE
SSC/MATRIC BOARD SSC/MATRIC PERCENTAGE 35.00
BOARD
SSC/MATRIC RESULT DATE 2013-03-20
SSSC(12TH) BOARD - SSSC(12TH) PERCENTAGE -
SSSC(12TH) RESULT DATE -
OTHER DETAILS
DO YOU POSSESS THE PRESCRIBED EDUCATIONAL QUALIFICATIONS AS
YES
PER THE ADVERTISEMENT / NOTIFICATION?
CHOICE OF EXAMINATION
DO YOU HAVE QUALIFICATION ABOVE 10+2? NO JAMMU
CENTER AT
I HEREBY DECLARE THAT I HAVE CAREFULLY READ THE ADVERTISEMENT NOTIFICATION FOR THIS POST AND
ALL THE TERMS AND CONDITIONS INDICATED THEREIN AND UNDERTAKE TO ABIDE BY THE TERMS AND
CONDITIONS OF THE ADVERTISEMENT / NOTIFICATION FOR PARTICIPATING IN THE SELECTION PROCESS. I
FULFILL ALL THE TERMS AND CONDITIONS MENTIONED IN THE ADVERTISEMENT NOTIFICATION AND THE
INFORMATION PROVIDED BY ME HEREIN IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I ALSO
UNDERTAKE THAT IN CASE OF FAILURE TO POSSESS THE QUALIFICATION PRESCRIBED IN THE ADVERTISEMENT
NOTIFICATION, THE BOARD WILL BE FULLY COMPETENT TO DEBAR ME FROM THE SELECTION PROCESS. I
FURTHER STIPULATE THAT I HAVE CAREFULLY READ THE GOVERNMENT NOTIFICATION AND ASSURE THAT I
AM NOT BARRED BY THE PROVISIONS OF THE SAID NOTIFICATION. I FURTHER UNDERTAKE THAT I SHALL NOT
CLAIM ANY BENEFIT OF ANY QUALIFICATION/CATEGORY THAT HAVE NOT SPECIFICALLY INDICATED IN THIS
ONLINE APPLICATION FORM. FURTHER, I AM AWARE THAT I WILL BE LIABLE FOR APPROPRIATE PENAL ACTION,
DISQUALIFICATION FROM THE SELECTION PROCESS OR LOSS OF THE JOB IN THE EVENT OF SELECTION HAVING
BEEN MADE, IF THE INFORMATION PROVIDED BY ME IS PROVED TO BE INCORRECT AT ANY STAGE.
