10/02/2016

PrintApplicationForm

HARYANAPUBLICSERVICECOMMISSION
Advertisement,Post&ChallanDetails

ForOfficeUseOnly
SpaceforMarking

AdvertisementNo.

:8

NameofPost

:AssistantEngineer(Mechanical)

RegistrationNo.

:2015211301

ChallanDetail

JournalNo.

Amount

:125

BankName

:StateBankofIndia

SignatureofMarkingOfficer

CandidateParticulars:
CandidateName

ANURAGSINGH

Father's/Husband'sName
Mother'sName

:
:

MAHAVIRSINGH
KIRANBALA

DateofBirth
AgeasperAdvt.

:
:

30/09/1994
20Years10Months2Days

Address

PermanantAddress:
Address

C/OMAHAVIRSINGH,VILLPARLA,
POKUND,PSKHOL,REWARI,
Secunderabad,Haryana123102
REWARIHaryana123102

C/OMAHAVIRSINGH,VILLPARLA,
POKUND,PSKHOL,REWARI,
Secunderabad,Haryana123102
REWARIHaryana123102

CorrespondenceAddress:

PersonalDetails:
HaveyoupassedHindi/Sanskritupto
:
Matriculation
Nationality
:
Gender
:
MaritalStatus
:

:
AreyoudomicileofHaryana?
:
Haveyoueverbeendebarredby
:
UPSC/HPSC/OTHERSStatePSCorany
otherGovt.Dept.?
Haveyoueverbeenconvictedby
:
Criminicalcourt?
AreyouemployedinGovt/Publicsector :
undertaking?(Ifyesandyouarein
regulararservicethengivedetailsand
havetosubmitNOCfromtheemployerat
thetimeofinterview).

Category
:

Yes
Indian
Male
UnMarried
Yes
No

No
No

BCA

ESM/DESM

Areyouchildrenorgrandchildrenof
freedomfighterofHaryana?
AreyouPhysicalHandicap?
PhysicalHandicapSubCategories

No

:
:

No

ContactDetails:
ContactNumber
EmailID

:
:

9493854297
anuragsingh7868@gmail.com

ExtraCoCurricularActivities:
Extracocurricular/sportsactivities

http://application.hpsconline.in/PrintForm.aspx

Pleasefixthe
OriginalPhoto
beforesubmitting
totheHPSC

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10/02/2016

PrintApplicationForm

NCC,NSS,culturalactivities

QualificationDetails:
Qual.
Examination
Name

Passing Marks Total

Year
Obtain Marks

Board/University Subjects

Div

500

79.80

Matriculation

class10

cbse

social
science,science,maths,english,hindi

2010

Intermediate

class12

cbse

maths,physicsandchemistry

2012

423

500

84.60

Graduation

BTech

jntuuniversity

Mechanical

2016

3221

4750

67.81

399

EssentialSpecificQualificationDetails:
ExperienceDetails:
Nill
Declaration:
(Tobesignedbythecandidate)
I.Allstatementsmadeinthisapplicationformaretrue,completeandcorrecttothebestofmyknowledgeandbelief.In
theeventofanyinformationbeingfoundfalseorincorrect,orineligibilitybeingdetectedbeforeoraftertheexamination
(Preliminary,Mainoronselection),mycandidaturemaybecancelledandactioncanbetakenagainstmebythe
Commission.
II.Ihavereadtheadvertisement,instructionstocandidatesandprovisionsintheBrochureoftheCommissionrelatedtothis
examinationcarefullyandIherebyundertaketoabidebythem.Ifulfillalltheconditionsofeligibilityregardingagelimit,
educationalqualificationsetc.prescribedforadmissiontotheexaminationintheadvertisement,instructionsforcandidates,
provisionofBrochureandotherrelevantrulesandinstructions.

Place:
Date:10/02/2016

CandidateSignature
ANURAGSINGH
Nameincapitalletters

[SignatureoftheCandidate]
(BeforesubmittingtheformtoHPSC)

Note:Incompleteandunsignedapplicationformshallberejected.

http://application.hpsconline.in/PrintForm.aspx

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