Application Form

Panchayti Raj Department, Govt. of Bihar

Application for Recruitment
Application Details
Application ID :     TAT/0005073 Application Date : 31-Aug-2018 Post Applied For : Technical Assistant
Personal Details
Applicant Name : NEEL MANI YAJEE
Father's /Husband's Name : KRISHNA KUMAR YEJEE
Date of Birth : 25-Nov-1994
Age on (01.08.2018) : 23 Years 8 Months
Gender : Male
Category : GEN
Nationality : Indian
Email ID : swatiyazi123@gmail.com
Mobile No. : XXXXXXX5796
Aadhar Type
Phone With STD Code :
Physically Handicapped No
Grand Children of Freedom Fighter No

Address for Correspondence

Address : AT.:BHATGAMA, P.S:SARAIRANJAN, P.O:SARAIRANJAN, DIST:SAMASTIPUR,BIHAR
Pin Code : 848127

Permanent Address
Address : AT.:BHATGAMA, P.S:SARAIRANJAN, P.O:SARAIRANJAN, DIST:SAMASTIPUR,BIHAR
Pin Code : 848127
State of Domicile : Bihar
Home District : SAMASTIPUR
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 B.S.E.B Bihar Government 2009 270 500 54
II.Intermediate/12th B.S.E.B Science Bihar Government 2012 333 500 66.6
IV.Diploma S.B.T.E PATNA Diploma in Civil Bihar Private 2016 1530 2250 68
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