3/8/2016 PrintApplicationForm

HARYANAPUBLICSERVICECOMMISSION

Advertisement,Post&ChallanDetails ForOfficeUseOnly

AdvertisementNo. :8 SpaceforMarking
NameofPost :AssistantEngineer(Civil)
RegistrationNo. :2015250256
ChallanDetail
JournalNo. :
Amount :500
BankName :StateBankofPatiala
SignatureofMarkingOfficer

CandidateParticulars:
CandidateName : SUNDERSINGH
Father'sName : JHANDURAM
Mother'sName : ROSHNIDEVI
DateofBirth : 12/11/1988
AgeasperAdvt. : 26Years8Months20Days
CorrespondenceAddress:
Address : V.P.OMOHABATPUR,TEHSILMANDI
ADAMPURHISARHaryana125052
Pleasefixthe

OriginalPhoto
PermanantAddress: beforesubmitting
Address : V.P.OMOHABATPUR,TEHSILMANDI totheHPSC
ADAMPURHISARHaryana125052


PersonalDetails:
HaveyoupassedHindi/Sanskritupto
: Yes
Matriculation
Nationality : Indian
Gender : Male
MaritalStatus : Married
:
AreyoudomicileofHaryana? : Yes
Haveyoueverbeendebarredby : No
UPSC/HPSC/OTHERSStatePSCorany
otherGovt.Dept.?
Haveyoueverbeenconvictedby : No
Criminicalcourt?
AreyouemployedinGovt/Publicsector : No
undertaking?(Ifyesandyouarein
regulararservicethengivedetailsand
havetosubmitNOCfromtheemployer
atthetimeofinterview).

Category : General
ESM/DESM :
Areyouchildrenorgrandchildrenof : No
freedomfighterofHaryana?
AreyouPhysicalHandicap? : No
PhysicalHandicapSubCategories :
ContactDetails:
ContactNumber : 8929659506
EmailID : sunder3.hce@gmail.com
ExtraCoCurricularActivities:
Extracocurricular/sportsactivities :
NCC,NSS,culturalactivities :

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3/8/2016 PrintApplicationForm

QualificationDetails:
Passing Marks Total
Examination Qual.Name Board/University Subjects % Div
Year Obtain Marks
ENGLISH,HINDI,MATH,
Matriculation 10th HBSE 2004 463 600 77.17 1
SSC,SCIENCE,PHYED.
Intermediate 12th HBSE NONMEDICAL 2006 287 500 57.40 2
Graduation BTECH MDUROHTAK CIVILENGINEERING 2011 4202 6150 68.33 1
TRANSPORTATION
PostGraduation M.TECH MDUROHTAK 2015 3321 4050 82.00 1
ENGINEERING

EssentialSpecificQualificationDetails:

ExperienceDetails:
Nill

Declaration:
(Tobesignedbythecandidate)
I.Allstatementsmadeinthisapplicationformaretrue,completeandcorrecttothebestofmyknowledgeandbelief.In
theeventofanyinformationbeingfoundfalseorincorrect,orineligibilitybeingdetectedbeforeoraftertheexamination
(Preliminary,Mainoronselection),mycandidaturemaybecancelledandactioncanbetakenagainstmebythe
Commission.
II.Ihavereadtheadvertisement,instructionstocandidatesandprovisionsintheBrochureoftheCommissionrelatedto
thisexaminationcarefullyandIherebyundertaketoabidebythem.Ifulfillalltheconditionsofeligibilityregardingage
limit,educationalqualificationsetc.prescribedforadmissiontotheexaminationintheadvertisement,instructionsfor
candidates,provisionofBrochureandotherrelevantrulesandinstructions.

CandidateSignature
SUNDERSINGH
Nameincapitalletters

Place:
Date:07/03/2016 [SignatureoftheCandidate]
(BeforesubmittingtheformtoHPSC)

Note:Incompleteandunsignedapplicationformshallberejected.

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