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Junior Engineer Examination Application Form 2019, Exercises of Mechanical Engineering

An application form for the junior engineer (civil, mechanical, electrical and quantity surveying & contracts) examination 2019. It includes personal information, educational qualifications, and examination center preferences of the applicant. The form also asks about the applicant's status as an ex-serviceman, person with disability, and age relaxation. Incomplete and requires the applicant to fill in their name as per matriculation certificate, father's name, mother's name, and date of birth, among other details.

Typology: Exercises

2019/2020

Uploaded on 07/15/2020

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STAFF SELECTION COMMISSION
BLOCK NO. 12, CGO-COMPLEX, LODHI ROAD, NEW DELHI
110003
JUNIOR ENGINEER (CIVIL, MECHANICAL,
ELECTRICAL AND QUANTITY SURVEYING &
CONTRACTS) EXAMINATION 2019
REGISTRATION NO: 30000576824
APPLICATION IS INCOMPLETE
1. NAME AS PER
MATRICULATION
CERTIFICATE
2. NEW/CHANGED
NAME
3. FATHER'S NAME
4. MOTHER'S NAME
VISHAL KUMAR MALL
-
MAKSUDAN MALL
VIMLA MALL
5. DATE OF BIRTH (DD/MM/YYYY)
6. AGE AS ON 01-01-2020
7. GENDER
10/02/1992
27.1
MALE
8. CATEGORY
9. NATIONALITY
10. MARK OF VISIBLE
IDENTIFICATION
OBC
CITIZEN OF INDIA
DARK MOLE ON RIGHT
CHEEK
11. MATRICULATION (10th CLASS) EXAMINATION
BOARD
12. MATRICULATION (10th
CLASS) ROLL NO
13. MATRICULATION (10th
CLASS) YEAR OF PASSING
BOARD OF HIGH SCHOOL AND INTERMEDIATE
EDUCATION UTTAR PRADESH
2486385
2006
14. PREFERENCE OF EXAMINATION CENTERS
15.WHETHER EX-
SERVICEMAN (ESM)?
15.1. HAVE YOU ALREADY
JOINED A CIVIL POST BY
AVAILING BENEFIT OF
RESERVATION FOR EX-
SERVICEMAN (ESM) :?
15.2. LENGTH OF SERVICE IN
ARMED FORCES ( IN YEARS )
15.3. DATE OF DISCHARGE
FROM ARMED FORCES
(DD/MM/YYYY)
NO
-
-
-
16. WHETHER PERSON WITH DISABILITY
(PWD) ?
16.1 IF YES, TYPE OF DISABILITY (OH, HH,VH, OTHERS)
NO
-
17. DO YOU HAVE A PHYSICAL LIMITATION TO WRITE AND SCRIBE IS REQUIRED TO WRITE ON YOUR BEHALF
(CERTIFICATE TO THIS EFFECT FROM THE CHIEF MEDICAL OFFICER/ CIVIL SURGEON & MEDICAL
SUPERINTENDENT OF A GOVERNMENT HEALTH CARE INSTITUTION AS PER NOTICE OF THE EXAMINATION
WOULD BE REQUIRED AT THE TIME OF EXAMINATION)?
NO
17.1 WHETHER SCRIBE IS REQUIRED
17.2 WILL YOU MAKE YOUR OWN
ARRANGEMENT OF SCRIBE?
17.3 IF SCRIBE IS TO BE
ARRANGED BY SSC, INDICATE
MEDIUM
NO
-
-
18. WHETHER SEEKING AGE RELAXATION?
18.1 IF YES,INDICATE CODE
NO
-
pf2

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STAFF SELECTION COMMISSION

BLOCK NO. 12, CGO-COMPLEX, LODHI ROAD, NEW DELHI

JUNIOR ENGINEER (CIVIL, MECHANICAL,

ELECTRICAL AND QUANTITY SURVEYING &

CONTRACTS) EXAMINATION 2019

REGISTRATION NO: 30000576824

APPLICATION IS INCOMPLETE

1. NAME AS PER

MATRICULATION

CERTIFICATE

2. NEW/CHANGED

NAME

3. FATHER'S NAME 4. MOTHER'S NAME

VISHAL KUMAR MALL - MAKSUDAN MALL VIMLA MALL

5. DATE OF BIRTH (DD/MM/YYYY) 6. AGE AS ON 01-01-2020 7. GENDER

10/02/1992 27.1 MALE

8. CATEGORY 9. NATIONALITY

10. MARK OF VISIBLE

IDENTIFICATION

OBC CITIZEN OF INDIA

DARK MOLE ON RIGHT

CHEEK

  1. MATRICULATION (10th CLASS) EXAMINATION BOARD
    1. MATRICULATION (10th CLASS) ROLL NO
      1. MATRICULATION (10th CLASS) YEAR OF PASSING BOARD OF HIGH SCHOOL AND INTERMEDIATE EDUCATION UTTAR PRADESH

14. PREFERENCE OF EXAMINATION CENTERS

EXAMINATION CENTER ( FIRST ) EXAMINATION CENTER ( SECOND ) EXAMINATION CENTER ( THIRD )

DELHI ( 2201 ) ROORKEE ( 2006 ) AJMER ( 2401 )

15.WHETHER EX-

SERVICEMAN (ESM)?

15.1. HAVE YOU ALREADY

JOINED A CIVIL POST BY

AVAILING BENEFIT OF

RESERVATION FOR EX-

SERVICEMAN (ESM) :?

15.2. LENGTH OF SERVICE IN

ARMED FORCES ( IN YEARS )

15.3. DATE OF DISCHARGE

FROM ARMED FORCES

(DD/MM/YYYY)

NO - - -

16. WHETHER PERSON WITH DISABILITY

(PWD)?

16.1 IF YES, TYPE OF DISABILITY (OH, HH,VH, OTHERS)

NO -

17. DO YOU HAVE A PHYSICAL LIMITATION TO WRITE AND SCRIBE IS REQUIRED TO WRITE ON YOUR BEHALF

(CERTIFICATE TO THIS EFFECT FROM THE CHIEF MEDICAL OFFICER/ CIVIL SURGEON & MEDICAL

SUPERINTENDENT OF A GOVERNMENT HEALTH CARE INSTITUTION AS PER NOTICE OF THE EXAMINATION

WOULD BE REQUIRED AT THE TIME OF EXAMINATION)?

NO

17.1 WHETHER SCRIBE IS REQUIRED 17.2 WILL YOU MAKE YOUR OWN

ARRANGEMENT OF SCRIBE?

17.3 IF SCRIBE IS TO BE

ARRANGED BY SSC, INDICATE

MEDIUM

NO - -

18. WHETHER SEEKING AGE RELAXATION? 18.1 IF YES,INDICATE CODE

NO -

19. POST(S) APPLYING FOR

JE- MECHANICAL ENGINEERING

20. QUALIFICATION DETAILS

HIGHEST TECHNICAL QUALIFICATION RELEVANT TO

THE POST OF INTEREST

SUBJECT/ STREAM

B. TECH MECHANICAL ENGINEERING

21. DO YOU BELONG TO ECONOMICALLY WEAKER SECTIONS (EWS)?

22. 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

ADDRESS DETAIL

  1. POSTAL ADDRESS 24. PERMANENT ADDRESS A 83 GULAB BAGH NAWADA VILLAGE GANGEBIR POST MADHUBAN

DISTRICT: WEST DELHI DISTRICT:MAU STATE: DELHI STATE: UTTAR PRADESH PIN : 110059 PIN : 221603 MOBILE NO: 9560107499 EMAIL: mallvishalkumar91@gmail.com SIGNATURE

FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE

NOT EXEMPTED 100 - -

DECLARATION

1. I HAVE READ THE NOTICE OF THE EXAMINATION AND ACCEPT ALL THE TERMS & CONDITIONS OF

THE NOTICE OF THE EXAMINATION.

2. 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. I AM WILLING TO SERVE ANYWHERE IN INDIA.

PRINT TAKEN ON: 19/08/2019 1:05:30 AM