Application Form

Panchayti Raj Department, Govt. of Bihar

Application for Recruitment
Application Details
Application ID :     TAT/0052682 Application Date : 09-Sep-2018 Post Applied For : Technical Assistant
Personal Details
Applicant Name : PANKAJ YADAV
Father's /Husband's Name : LAL CHANDRA YADAV
Date of Birth : 19-Aug-1993
Age on (01.08.2018) : 24 Years 11 Months
Gender : Male
Category : GEN
Nationality : Indian
Email ID : pankaj1211yadav@gmail.com
Mobile No. : XXXXXXX4525
Aadhar Type Aadhar No
Aadhar No XXXXXXXX1997
Phone With STD Code :
Physically Handicapped No
Grand Children of Freedom Fighter No

Address for Correspondence

Address : VILL-MATHIYA MAHUWARI POST-RENDA DIST-AZAMGARH STATE-UTTAR PRADESH
Pin Code : 276204

Permanent Address
Address : VILL-MATHIYA MAHUWARI POST-RENDA DIST-AZAMGARH STATE-UTTAR PRADESH
Pin Code : 276204
State of Domicile : Uttar Pradesh
Home District : OTHER
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 UP BOARD Uttar Government 2008 389 600 64.83
Pradesh
II.Intermediate/12th UP BOARD Science Uttar Government 2010 360 500 72
Pradesh
IV.Diploma BTE BOARD Diploma in Uttar Government 2014 1819 2400 75.79
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