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ON-LINE APPLICATION FOR TNPSC REGISTRATION

22030
Registration # : 600178

Full Name :

D SUGUMAR

One Time ID : Name of The Post Applying for : Are you a Destitute Widow? : Are you a Differently Abled Person? : Are you an Ex-Serviceman ? : PPO No : Date of Discharge / Probable Discharge / Date : Are you a Government Employee? : Nationality / Citizenship : Application Fee / Intimation Charges details: Payment Mode: Amount : Personal Details : Date of Birth : Gender : Married : Spouse's Name : Religion : Candidate's Place of Birth : Native District : Father's Name : Father's Place of Birth : Mother Tongue : Mother's Name : Communal Category : Name of the Sub Caste : Certificate No : Date Of Issue : Issuing Authority : Taluk : District : Address for Correspondence :

12322686 Combined Engineering Services Examination NA NO NO --NO Indian

Net Banking 125.00

10/12/1979 MALE Yes AEZHISAI VALLAVI M S Hindu NAMAKKAL Namakkal M DURAISAMY Namakkal Tamil D SAROJA Backward Class(BC) KONGU VELLALAR 593058 23/05/1995 Deputy Tahsildar Namakkal Salem PAAVENDHAR ILLAM 17,JOTHIPURAM

District State : Pin : Permanent Address :

Coimbatore Tamil Nadu 641047 PAAVENDHAR ILLAM 17,JOTHIPURAM

District State :

Coimbatore Tamil Nadu

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Pin : Contact Details : Email ID : Mobile No : EDUCATIONAL QUALIFICATION PARTICULARS : Exam Passed S.S.L.C : H.S.C : Degree : Post Graduate Degree : Others : Whether studied Tamil as one of the subject : Details regarding the prescribed qualification : Qualification Details : Other Equivalent Qualification Details : Certificate No : Year of Passing : Name of the Authority/ University : Preferential qualification for per notification : Preferential Physical Standards for per notification : Name of the Examination Centre : Optional Subject (As per Notification) : Do you claim Age Concession? : Do You Claim Fee Exemption? : Post Preference : Criminal Case (Registered/Pending/Punishment awarded) : Participation in Political Activities (In agitation/As a Member of Political Organisation/Candidature in Election) : Post Qualification work experience (Start from present Employer) : Name of the Organisation Karunya University Karunya University Karunya University Karunya Institute of Technology Previous appearance for Oral Test / Written Test Name of the Post Register No. Year Designation Assistant Professo r Lecturer Lecturer Lecturer From(mm/yyyy) 01/2009 06/2007 09/2004 08/2002 To(mm/yyyy) 03/2012 12/2008 08/2005 08/2004 Nature of Duty Teaching Teaching Teaching Teaching B.E (Electronics and Communication Engineering) -r551618 2002 Bharathiyar Yes No Coimbatore Electronics and Communication Engineering (Code No.044) No No 1.Assistant Engineer (Electrical) PWD 2.Junior Electrical Inspector Not Applicable Not Applicable Year of Passing 1995 1997 2002 2007 Medium of Instruction Tamil Tamil English English N/A N/A others others -sslc N/A N/A ELECTRONICS AND COMMUNICATION COMMUNICATION SYSTEM Degree Major Subject sugumar.ssd@gmail.com 9629451775 641047

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DECLARATION:
1. I hereby declare that all the particulars furnished in this application are true, correct and complete to the best of my knowledge and belief. In the event of any information being found false or incorrect or ineligibility being detected before or after the examination, action can be taken against me by the TNPSC. 2. I hereby declare that I will not be a party to any kind of canvassing on my behalf.

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3. I further declare that I fulfil all the eligibility conditions prescribed for admission to the examination.

4. I have informed my employer in writing that I am applying for this Examination.

5. I have gone through the Instructions etc. to candidates and the Commissions notification for this Recruitment before filling up the application form.

6. I declare that I possess the medical standards prescribed for the post(s) which I am now applying.

7. I certify that I have not been debarred by the TNPSC or any other recruiting agency.

8. I am not a dismissed Government Employee.

I accept the above declaration

Place:

Date: 2013-01-17 19:31:27

Signature of Applicant

Please retain your Registration No. and Password emailed to you carefully for further reference