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Staff Selection Commission

(Block No. 12, CGO-Complex, Lodhi Road, New Delhi


110003 )
Combined Graduate Level Examination-2017
Registration No: 64007289358

Application Status: Application provisionally submitted

Name of the Examination Centre Examination Centre Code


MPR-Raipur(6204) 6204
MPR-Durg(6205) 6205
MPR-Bilaspur(6202) 6202
Candidate's Full Name Father's Name Mother's Name Date of Birth
ABHAY NATH PRASAD JAGDISH PRASAD RITA DEVI 1990-01-19
Gender Nationality Fee Category
Male Indian Fee Paid OBC
Whether Ex-serviceman If,ExS,whether seeking Length of Service Date of Discharge
reservation?
No
Whether PH? If yes,indicate code Whether seeking Age If yes,indicate code Age as on (01.08.2017)
relaxation?
No Yes OBC 27.6
Preference for Group of Are you applying for the Do you possess EQ for the Are you applying for the Do you possess EQ for the
Posts: Posts of Junior Statistical Posts of Junior Statistical Post of AAO? Posts of AAO?
Officer? Officer?
ABCD Yes Yes Yes Yes
Whether belong to Minority If VH/Celebral Palsy/Locomotor If yes,indicate medium Mark of visible identification
Communities as per Govt. Orders? candidate,whether scribe is
required?
No No
Mode of Fee Payment Amount Transaction-ID Transaction Date
Online 100 IK00FHBSB6 2017-06-15
Educational Qualiication(Please note that possession of Graduate Qualification is a pre-requisite to apply for this examination,However you may
indicate your highest qualification) Indicate Code
B.Tech

Do you want to make available your personal information for accessing job opportunity in terms of Dop&T's O.M
No.39020/1/2016-Estt.(B) dated 21.06.2016?
No

Details of Work Experience/Govt. Service rendered


Name of the Organization Designation Nature of Duty(ies) Period of Service
SHANKER INDUSTRIES MINES MANAGER MINES SAFETY 01/2014-06/2017

Address Detail
Communication Address Permanent Address
VILLAGE SHUBHANKARPUR POST SHUBHANKARPUR VILLAGE- KHARGAMA POST AMAUJA THANA PHULPARAS
DIST MADHUBANI
City: MUHALLA NAGESHWARNATH TOLA State: Bihar
District: DARBHANGA Pin Code: 847402
State: Bihar Mobile No.: 8962478819
Pin Code: 846006 Email Id: abhaynitrr@gmail.com

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 suppressed/false or incorrect or ineligibility
being detected before or after the examination, my candidature/appointment is liable to be cancelled

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