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ON-LINE APPLICATION FOR RECRUITMENT OF CLERICAL STAFF (Clerks / Stenographers)

28041
Registration # : 4001701780

Full Name :

SANTOSH KUMAR PRADHAN

Have you applied for the post of Clerk under vacancies advertised vide CRPD advertisement CRPD/CR/2011-12/05 dated 27.12.2011? : If yes, please specify Registration Number (You have the option to apply for the post(s) of Stenographer): Post Applied for : State/UT Applied for : Category : If Person with Disability : Type of Disability : Percentage of Disability :

NO

Clerk Orissa GENERAL NO -

Do you intend to use the services of a scribe (only for VI & OH candidates whose writing NA speed is affected by cerebral palsy) ? : Are you candidate who had ordinarily been domiciled in Kashmir Division of the State of J & K during the period 1-1-1980 to 31-12-1989 ? : Whether you belong to Religious Minority Community ? : Religion to which you belong : Are you an Ex-Serviceman ? : Are you Disabled Ex-Serviceman (DXS) ? : Are you a Matriculate ? : Have you obtained the Indian Army Special Certificate of Education or corresponding certificate in the Navy or the Air Force, after having completed not less than 15 years of service in Armed Forces of the Union : Are you Dependent of an Ex-Serviceman killed in action ? : Are you seeking relaxation under widow /divorced women / women judicially Separated from their husbands and who are not re-married ? : Nationality / Citizenship : Centre of Examination : Centre Code : Application Fee / Intimation Charges details: Payment Mode: Amount : Personal Details : Date of Birth : Age completed as on 01.12.2011 : Gender : Husband's Name/Father's Name : Mother's Name : Address for Correspondence : 09-05-1989 22 MALE BHAJAMAN PRADHAN SEBATI PRADHAN RUPABANI HOUSE C.T.ROAD State : Pin : Permanent Address : ORISSA 752002 RUPABANI HOUSE C.T.ROAD ONLINE 350.00 NO NO INDIAN Bhubaneswar 27 NO NO NO NO

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State : Pin : Contact Details : Email ID : Phone No : Mobile No : Qualification Details (as on 01.12.2011): Exam Passed SSC/Equivalent : HSC/ 12th(10+2) / Equivalent : Other Details : Knowledge of Stenography : Would You like to undergo Pre-Exam Training (SC/ST/Minority Community/ XS / DXS / Dependents of XS) : If Yes Centre for Training : Languages Known English HINDI ORIYA Read YES YES YES NO --Write YES YES YES Speak YES YES YES Subject /Stream ALL ARTS Date of Passing 15-03-2004 21-06-2006 % of Marks 35.00 60.33 prashant.wd@gmail.com 9124838339 ORISSA 752002

DECLARATION:
I hereby declare that all statements made in this application are true. complete and correct to the best of my knowledge and belief. I understand that in the event of any information being found untrue or incorrect at any stage or my not satisfying any of the eligibility criteria according to the Central Recruitment & Promotion Department, my candidature is liable to cancelled. I am willing to serve anywhere in India including rural areas.

Place:

Date: 24-03-2012

Signature of Applicant

Please retain your Registration No. and Password emailed to you carefully for further reference NOTE: Please DO NOT SEND application printout to CRPD/ SBI