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ON-LINE APPLICATION FOR TNPSC REGISTRATION

24032
Registration # : 401021466

Notification. No. :

01/2014

Full Name : One Time ID : Name of The Post Applying for : Are you a Destitute Widow? : Are you a Differently Abled Person? : Are you an Ex-Serviceman ? : PPO No : Date of Discharge / Probable date of Discharge : Are you a Government Employee? : Nationality / Citizenship : Application Fee / Intimation Charges details: Payment Mode: Amount : Personal Details : Date of Birth : Gender : Marital Status : Religion : Candidate's Place of Birth : Native District : Father's Name : Father's Place of Birth : Mother Tongue : Mother's Name : Communal Category : Name of the Sub Caste : Certificate No : Date Of Issue : Issuing Authority : Taluk : District : Address for Correspondence :

V SEENIVASAN 13376814 Personal Clerk in Finance Department, Secretariat (Post Code No: 1079),Personal Clerk in Tamil Nadu Public Service Commission (Post Code No:1082),Assistants in various departments NA NO NO --NO Indian

Net Banking 75.00 23/03/1986 MALE UnMarried Hindu SALEM Salem C VIJAYAN Salem Tamil V SAKTHI Most Backward Class(MBC) Vanniyar 4083319 08/07/1993 Deputy Tahsildar (Certificates) Salem Salem OLD NO 100/1 NEW NO 5/406 ALAGAPURAM KAATUR

District State : Pin : Permanent Address :

Salem Tamil Nadu 631016 OLD NO 100/1 NEW NO 5/406 ALAGAPURAM KAATUR

District

Salem

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State : Pin : Contact Details : Email ID : Mobile No : EDUCATIONAL QUALIFICATION PARTICULARS : Exam Passed Date of Publication of Results 30/05/2002 12/05/2004 23/09/2008 Medium of Instruction Tamil Tamil Tamil Degree Major Subject Board / University STATE BOARD STATE BOARD PERIYAR iclubsalem@gmail.com 9344001607 Tamil Nadu 631016

S.S.L.C : H.S.C or Equivalent Qualification : Degree : Others :

N/A H.S.C B.B.A. -No

N/A N/A ADMIN

Do you claim reservation for Persons Studied in Tamil Medium (PSTM)? : Details regarding the prescribed qualification : Qualification Details : Other Equivalent Qualification Details : Certificate No : Year of Passing : Name of the Authority/ University : Do you possess Special / Preferential qualification? : Physical Standards as per notification :

Any Degree -2KH034944 2008 PERIYAR No Yes English Type Writing Short hand -Cert. No. Issued by Dir. of Cert. No. Issued by Dir. Tamil Technical Education of Technical Education ----

Type writing / Short hand Qualification

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Name of the Examination Centre District: Name of the Examination Centre : Optional Subject : Do you claim Age Concession? : Under What Category? : Do You Claim Fee Exemption? : Under What Category? : No of free Attempts : Criminal Case (Registered/Pending/Punishment awarded) : Participation in Political Activities (In agitation/As a Member of Political Organisation/Candidature in Election) : Post Qualification work experience (Start from present Employer) : Name of the Organisation Previous appearance for Oral Test / Written Test Name of the Post Designation

Salem Salem General Studies (Degree Standard) with General Tamil (S.S.L.C Standard) Yes Most Backward Class/Denotified Community Yes Most Backward Class/Denotified Community 2 Not Applicable Not Applicable

From(mm/yyyy)

To(mm/yyyy)

Nature of Duty

Register No.

Year

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DECLARATION:
1. I hereby declare that all the particulars furnished in this application are true, correct and complete to the best of my knowledge and belief. In the event of any information being found false or incorrect or ineligibility being detected before or after the examination, action can be taken against me by the TNPSC. 2. I hereby declare that I will not be a party to any kind of canvassing on my behalf.

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3. I further declare that I fulfil all the eligibility conditions prescribed for admission to the examination.

4. I have informed my employer in writing that I am applying for this Examination.

5. I have gone through the Instructions etc. to candidates and the Commissions notification for this Recruitment before filling up the application form.

6. I declare that I possess the medical standards prescribed for the post(s) which I am now applying.

7. I Certify that I have not been debarred / disqualified by the TNPSC or any other recruiting agency.

8. I am not a dismissed Government Employee.

I accept the above declaration

Place:

Date: 2014-02-08 17:18:56

Signature of Applicant

Please retain your Registration No. and Password emailed to you carefully for further reference