1/2

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

This online application is povisional subject to payment of application fees/ intimation charges

30031
Registration # : 4001329038

Full Name :

Satyajit Routroy

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 : 11-12-1988 22 MALE Bikram Keshori Routroy Shailabala Routroy MIG - 111 Anantavihar Phase -2 Near DAV School Pokhariput Bhubaneswar District State : Khurda ORISSA CBS 350.00 NO NO INDIAN Bhubaneswar 27 NO NO NO NO

2/2
Pin : Permanent Address : 751020 MIG - 111 Anantavihar Phase -2 Near DAV School Pokhariput Bhubaneswar District 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 : Graduation/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 Oriya Science B TECH Date of Passing 25-06-2004 31-05-2006 10-08-2010 % of Marks 51.00 51.00 62.00 tulu_biet@rediffmail.com 9776190654 Khurda ORISSA 751020

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: 22-03-2012

Signature of Applicant

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