4/3/2019

GOVERNMENT OF MAHARASHTRA
MAHAPARIKSHA MUMBAI , MAHARASHTRA
Maharashtra Information Technology Corporation Ltd. (MAHA IT), 514, 5th Floor, Mantralaya,
Hutatma Rajguru Chowk, Madam Cama Road, Mumbai - 400032
E-mail:enquiry@mahapariksha.gov.in

Personal Details
Posts/Services Applied for Laboratory Technician_Chandrapur-Non PESA
Application Id RDD_LT_CHA_0123138
First Name SAROJINI
Middle Name SAJJAN
Last Name KHOBRAGADE
Mother's Name MALAN SAJJAN KHOBRAGADE
Father's Name SAJJAN SITARU KHOBRAGADE
Nationality INDIAN
No of Children 0
Whether liable to be disqualified for the Government Services according to the
provisions of Maharashtra Civil Services (Declaration of small family) Rules, 2 No
005?
Gender FEMALE
Date of Birth May 29, 1984
Candidate's Name SAROJINI KHOBRAGADE
Mobile Number 8766854028
Marital Status SINGLE
Name Change Status NOT CHANGED
Changed First Name NOT APPLICABLE
Changed Middle Name NOT APPLICABLE
Changed Last Name NOT APPLICABLE
Category of the Candidate SC

Note:Candidate opting for reservation category have to provide original caste category certificate during document verification else your reservation benefits will be rejected.

Caste Certificate APPLICABLE

Caste Validity Certificate APPLICABLE
Caste Certificate Number 277
Place of Issue BHANDARA
Date Of Issue Jul 7, 2000
Are you ST-PESA Candidate ? NOT APPLICABLE

Note: ST PESA vacancy is applicable for local Scheduled Tribe Candidates only, if original documents are not provided by candidate during document verification, then ST PESA reservation benefits will be
rejected for the selected ST PESA district.

Is there sufficient revenue proof that the candidate himself or his mother / father or gr
andfather / grandfather is staying in the Scheduled Areas of the district (ST PESA Di NOT APPLICABLE
strict which the candidate wants to apply for) continuously since January 26, 1950?
Do you want to apply to ST-PESA vacancies? NOT APPLICABLE
Candidate is resident of which scheduled area (District)? NOT APPLICABLE
Physical Disability NOT APPLICABLE

Note:Medical certificate of disability issued by competent authority prior to SADM and the other certificates or SADM will be accepted once verified at the time of document verification by the concerned
ZillaParishad appointing authority.

Do you have disability certificate (minimum 40%)? (SADM, Software for Asses
NOT APPLICABLE
sment of Disability)
One Arm affected(OA) NOT APPLICABLE
One Leg affected(OL) NOT APPLICABLE
Both Leg affected(BL) NOT APPLICABLE
Both Arm affected(BA) NOT APPLICABLE
One Arm and Leg affected NOT APPLICABLE
Low vision NOT APPLICABLE
Hearing Handicapped NOT APPLICABLE
Blind NOT APPLICABLE
Scribe/Assistant Needed NO
Aadhaar Card Number 486136053967
Aadhaar Enrollment Number NOT APPLICABLE
Are you Orphan as per Women and Child Development Department's Governm
NOT APPLICABLE
ent Resolution No. अमुजा- २०११/ . . २१२/ का- ३, िद. २ एि ल २०१८ ?
Project Affected or Dependent on Project Affected? NOT APPLICABLE
Earthquake Affected (Whether death of any family member or the house collap
NOT APPLICABLE
sed in the earthquake has been rebuilt by the government ?)

Are you Anshakalin (Part-time) Employee? (As per reference GR शासन िनणय क्
NOT APPLICABLE
र. प अंक -१००९/ . . २०० /२००९/१६-अ ,िद . २७. १०. २००९)

1/2
4/3/2019
Name of Office(for Anshkalin Employee): NOT APPLICABLE
Appointing Authority (for Anshkalin Employee): NOT APPLICABLE
Part Time Experience in Years NOT APPLICABLE
Part Time Experience in Months NOT APPLICABLE
Part Time Experience in Days NOT APPLICABLE
Do you have MSCIT certification or equivalent certification ? APPLICABLE
Marathi Language Proficiency(READ) APPLICABLE
Marathi Language Proficiency(WRITE) APPLICABLE
Marathi Language Proficiency(SPEAK) APPLICABLE
Are you son/daughter of a farmer who committed suicide? NOT APPLICABLE
Non-Creamy layer certificate NOT APPLICABLE
Are you an Ex-Serviceman? NOT APPLICABLE
Retired Ex-Service man NOT APPLICABLE
Years of service (Ex-Servicemen) NOT APPLICABLE
Differently abled Ex-Serviceman NOT APPLICABLE
Are you a Government /Semi-Government /Local bodies employee/Regular em APPLICABLE
ployee of Zilla Parishad?
Name of the Office/Department: DRDA BHANDARA
Joining date: May 2, 2012
Sports Quota NOT APPLICABLE
Meritorious sportspersons Reservation: NOT APPLICABLE
Have you sent all sports certificate from director/deputy director, sport for
NO
verification?
Domicile of Maharashtra YES
Are you an Election employee as per the GR dated 6th Oct, 2010? NO
Are you a census Employee of 1991? NO
Are you a pupil or ward Nominated by freedom fighter? NO
Are you a dependent of Ex-servicemen as per GR mentioned in advertisemen
NO
t?
Do you want to avail the benefit of female Reservation? APPLICABLE
I have read the advertisement and agree with the instruction, terms, Selected district (Zila Parishad Appoi
conditions and eligibility criteria mentioned in the advertisement re
YES nting Authority) you want to apply for LT
quired for the service/post which I am applying. I agree that I fulfill a
this post :
ll the eligibility criteria required for this Service/post.
Address Details of the Candidate
Address Type Address
Both Permanent and Current Addr
NEW SHESH NAGAR PAUNI NEAR MAIN BUS STAND PAUNI,PAUNI, , MAHARASHTRA, 441910
ess
Educational Qualification Details
Name of the B
Educational Name of the Qualified Marks Marks
oard/Universit Passed on Percentage Percentile CGPA GRADE
Qualification course from Obtained Maximum
y Name
The Rashtrasa
B.Ed or Equiv MAHARASHT nt Tukadoji Ma NOT APPLI NOT APPLI NOT APPLI
GRADUATE May 30, 2008 411 700 58.71
alent RA haraj Nagpur U CABLE CABLE CABLE
niversity
The Rashtrasa
POST-GRADUA MAHARASHT nt Tukadoji Ma NOT APPLI NOT APPLI NOT APPLI
M sc. zoology Jul 2, 2007 518 1000 51.8
TION RA haraj Nagpur U CABLE CABLE CABLE
niversity
The Rashtrasa
MAHARASHT nt Tukadoji Ma NOT APPLI NOT APPLI NOT APPLI
GRADUATE B.Sc_Biology Jun 25, 2005 696 1350 51.56
RA haraj Nagpur U CABLE CABLE CABLE
niversity
Maharashtra St
ate Board of Se
NOT APPLI NOT APPLI NOT APPLI
HSC condary and Hi Aug 22, 2002 282 600 47
CABLE CABLE CABLE
gher Secondar
y Education
Maharashtra St
ate Board of Se
NOT APPLI NOT APPLI NOT APPLI
SSC condary and Hi Jun 14, 2000 454 750 60.53
CABLE CABLE CABLE
gher Secondar
y Education
Exam Center Details
Preferred Exam Center Location1 Preferred Exam Center Location2 Preferred Exam Center Location3
BHANDARA NAGPUR AMRAVATI
Payment Details
Transaction Type Transaction Id Transaction Status Transaction Date Total Fees
ONLINE MAHAIT_RDD_000000106603 failure 01/04/2019 03:25 PM 500
ONLINE MAHAIT_RDD_000000140336 SUCCESS 03/04/2019 08:00 AM 500
Before logging on to the registration portal
Sr.No Undertakings
1. I have read and understood the instruction booklet carefully before filling in the form.
2. I have scanned my photograph and signature ready on my desktop confirming to the specified standards mentioned in the information Brochure.
3. I have downloaded the Online information brochure and read it carefully before filling the form.
4. I have the details for payment (Credit Card / Debit Card / Internet Banking) available with me for making Online payment.
5. I agree that my application form will be treated as complete only if I finally submit the application along with the payment of necessary fees.
6. I agree to bear the payment gateway additional charges
7. I accept to receive messages from MAHA-IT even if my mobile number falls under Opt-in and / or DND (Do Not Distrub)/ DNC(Do Not Call) category.
Before submitting the form
Sr.No Undertakings
1. I fulfill the conditions as specified in the eligibility criteria and registration guidelines.
2. All the particulars provided by me in this application are true, correct and complete to the best of my knowledge and belief.
I shall produce all the original documents along with the attested copies as and when required, failing to which I will be considered as blacklisted
3.
and debarred.
In case any particulars given by me in this application are found to be false, incorrect and /or misleading, I shall be liable for being blacklisted or
4.
debarred from all further examinations and selection processes of the Rural Development Department.
Printed On:03/04/2019 08:02:39 AM

2/2