J&K SERVICES SELECTION BOARD
GOVERNMENT OF JAMMU & KASHMIR
APPLICANT ID: 4602051053 APPLICATION DATE: 2020-07-22
APPLIED APPLICATION FORM FOR APPOINTMENT TO CLASS-IV
ADVERTISEMENT NUMBER - 01 OF 2020
PERSONAL DETAILS
APPLICANT NAME MR BABLU KUMAR GENDER MALE
FATHER'S NAME GARU RAM MOTHER'S NAME NEELAM KUMARI
DATE OF BIRTH 1993-07-05 AGE AS ON 01.01.2020 26
PHONE NUMBER 7298491487 EMAIL BABLUKUMAR7298534405@GMAIL.COM
WHETHER MARRIED NO WHETHER DOMICILE YES
DOMICILE DIVISION JAMMU DOMICILE DISTRICT JAMMU
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. HOUSE NO 98 SHANKER VIHAR TALAB TILLO
NUMBER
VILLAGE/TOWN/CITY JAMMU PANCHAYAT
BLOCK - TEHSIL JAMMU
DISTRICT JAMMU (JAMMU DIVISION) PINCODE 180002
PERMANENT ADDRESS
LOCALITY/MOHALLA/WARD
HOUSE NO./ROOM NO. HOUSE NO 98 SHANKER VIHAR TALAB TILLO
NUMBER
VILLAGE/TOWN/CITY JAMMU PANCHAYAT
BLOCK - TEHSIL JAMMU
DISTRICT JAMMU (JAMMU DIVISION) PINCODE 180002
CATEGORY OF APPLICANT
CATEGORY SC DATE OF ISSUE OF CATEGORY CERTIFICATE
CATEGORY CERTIFICATE ISSUING AUTHORITY
CANDIDATE WHOSE FAMILY MEMBER NEITHER IS NOR
WHETHER YOU BELONG TO ANY SUCH SECTION / CATEGORY WHICH IS ELIGIBLE FOR
HAS BEEN IN GOVERNMENT SERVICE
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
NO FIR(S) DETAILS -
AGAINST YOU?
WHETHER ANY PROSECUTION IS PENDING IN ANY COURT
NO
OF 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
NO DETAILS -
YOU?
SECTION UNDER WHICH CHARGESHEET HAS
NATURE OF OFFENCE - -
BEEN FILED
WHETHER ANY DISCIPLINARY ACTION HAS BEEN INITIATED
BY GOVERNMENT/SEMI-GOVERNMENT ORGANISATIONS NO DETAILS -
AGAINST YOU?
QUALIFICATION DETAILS
WHETHER SSSC(12TH) QUALIFIED NO
JK STATE
SSC/MATRIC BOARD SSC/MATRIC PERCENTAGE 46.80
BOARD
SSC/MATRIC RESULT DATE 2009-05-26
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.
