Application Form

Panchayti Raj Department, Govt. of Bihar

Application for Recruitment
Application Details
Application ID :     TAT/0052286 Application Date : 09-Sep-2018 Post Applied For : Technical Assistant
Personal Details
Applicant Name : MD REYAZ AHMAD
Father's /Husband's Name : ABDUL KHALIQUE
Date of Birth : 07-Oct-1990
Age on (01.08.2018) : 27 Years 9 Months
Gender : Male
Category : GEN
Nationality : Indian
Email ID : mdreyazr1@gmail.com
Mobile No. : XXXXXXX8796
Aadhar Type Aadhar No
Aadhar No XXXXXXXX7826
Phone With STD Code :
Physically Handicapped No
Grand Children of Freedom Fighter No

Address for Correspondence

Address : MD REYAZ AHMAD
S/O- ABDUL KHALIQUE (TYPIEST)
DHARAMPUR, CHAKNOOR ROAD,
WARD NO- 02
Pin Code : 848101

Permanent Address
Address : MD REYAZ AHMAD S/O- ABDUL KHALIQUE (TYPIEST) DHARAMPUR, CHAKNOOR
ROAD, WARD NO- 02
Pin Code : 848101
State of Domicile : Bihar
Home District : SAMASTIPUR
Choice District : SAMASTIPUR

Educational Qualification
  Board/University Specialization State Whether Passing Marks Full Marks Marks
Government or Year Obtained (Excluding Obtained
Private (Excluding Extra  (%)
Extra Subject)
Subject)
I.Matric BSEB PATNA Bihar Government 2005 395 700 56.43
II.Intermediate/12th BSEB PATNA Arts Bihar Government 2009 326 500 65.2
IV.Diploma MANUU Diploma in Andhra Government 2012 3428 4300 79.72
HYDERABAD Civil Pradesh
Engineering
V.Additional 0 0 0 0
Qualification

I declare that all the above information is correct to the best of my knowledge and that I shall be liable for punishment if
any information is found incorrect. I also declare that I have understood the guideline for engagement and will fully abide
by the same including any future guideline issued by Panchayti Raj Department in this regard.

Place:-

Date:-
Signature of Applicant