APPLICATION FOR RECRUITMENT OF PANCHAYAT SECRETARIES GRADE IV - WARANGAL

Personal Details
1 2 3 4 5 6 Reference Id : Name : Father/ Husband Name : Date of birth : Gender : Address for communication : 6000013618 GUGULOTH GANESH GUGULOTH SEETHARAM 23/07/1990 Male HNO 2-61 EASTTHANDA AGAPET AGAPET Warangal 506324 2-61 EAST THAMDA AGAPET NARASIMHULAPET Warangal 506324 ganesh.gvc225s@gmail.com 8686774422 Yes ST No No

District : Pincode : Permanent Address :

*6000013618*

District : Pincode : 8 e-Mail : 9 Mobile : 10 Do you belong to Warangal District : 11 Community you Belong : 12 Are you an Ex-Service Men: 13 Are you a Physically Handicapped(PH) Person: 14. Identification Marks 1 A MOLE ON THE FORE HEAD 2 A MOLE ON THE LEFT HAND SECOND FINGER
15. Qualification Details

S. No

Qualificatio Name of the n Institute 1 SSC BHARATHI VIDYA MANDIR 2 INTERMEDI EKASHILA ATE JR CLG 3 DEGREE MASTERJI DEGREE CLG

Board/Univ Duration of ersity Study SECONDAR 2004-2005 Y B0ARD INTERMIDA TE BOARD KU 2005-2007 2008-2011

Year of Pass May 2005 June 2008 June 2011

Total Marks 600 1000 1800

Marks Secured 496 573 1116

Marks Percentage 82.67 57.3 62

16. Education Details

School Study : Regular 4 th Class 5 th Class Warangal Warangal 1

6 th Class Warangal

7 th Class Warangal

8 th Class Warangal

9 th Class Warangal

10 th Class Warangal

17. Experience Details

Did you work as a contract employee at panchayat No secretary :

I hereby declare that all the entries/statements made in this application are true, complete and correct to the best of my knowledge and belief. I have not been convicted /involved in criminal cases. In the event of any information being found false or incorrect or ineligibility being detected before or after the final application submission, I shall be liable for action as per rules. Date : 01/12/2013 02:52:26 PM

Sd/GUGULOTH GANESH

Note:The candidates should take printout and submit the application form with Rs.50/- D.D or I.P.O drawn in favour of District Panchayat Officer, Warangal, along with the attested copies of Memos of SSC, Inter,Degree,Caste Certificate and Residence Certificate in the Office of District Panchayat Officer, Warangal, at Collectorate as per the notification.