GOVERNMENT OF PUDUCHERRY

Department of Revenue and Disaster Management

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Application for Recruitment to the post of VILLAGE ADMINISTRATIVE OFFICER
(Pay Band - 1: `5200-20200 with Grade Pay: `2400/-)
26484
POST APPLIED
Name of the Post Code Number
VILLAGE ADMINISTRATIVE
OFFICER
01
Applicant's Specimen Signature:
1. Application Number : 26484
2. Name of the Applicant : Mr. VIJAY P
3. Father's Name : PACHAIAPPAN R
4. Mother's Name : SAROJA P
5. Spouse's Name (if married) :
6. Date of Birth : 06/09/1985
7. Age as on 22/01/2014 : 28 years and 4 months
8. Gender : Male
9. Address :
Address for Communication Permanent Address
E-34.
VIDUTHALAI NAGAR
MUDALIARPET
PUDUCHERRY - 605004
E-34
VIDUTHALAI NAGAR
MUDALIARPET
PUDUCHERRY - 605004
10. Mobile Number : +919677273569
11. E-Mail Id : vijay2_85@hotmail.com
12. Educational Qualifications :
Sl.
No.
Qualification Name of the Board
Month & Year
of Passing
1 SSLC or equivalent
STATE BOARD OF MATRICULATION,
TAMILNADU
Jun, 2001
2
H.Sc / 3 years Diploma or
equivalent
STATE BOARD OF SCHOOL
EXAMINATIONS, TAMILNADU
May, 2003
13. Technical Qualifications :
Name of the
Course
Duration of Course
(in Months)
Month & Year of
Passing
Name of the
Institution
Wether recognized
by Government
C CPLUS 3 Jun, 2005 SSI EDUCATION Yes
14. Nationality : INDIAN
15. Whether Native / Resident of
Puducherry
: Yes
16. Religion : HINDU
17. Have Regd in Emp Exchange? : Yes
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6.

DECLARATION

I have read the provisions in the Notification of the examination carefully and hereby undertake to abide
by them.

I declare that I am a Native / Resident of Union Territory of Puducherry by virtue of continuous
residence for the last five years immediately preceding the date of Notification and I understand that any
deviation in this regard will render my selection invalid.

I have not submitted any other application for this examination. I am aware that if I contravene this, my
application will be summarily rejected.

I further declare that I fulfill all the conditions of eligibility regarding age limits, educational
qualification, technical qualification etc., prescribed for admission to the examination.

I also declare that I have never been convicted by any court of law. I also declare that no charge sheet is
pending against me in any court of law.

I understand that success in examination confers no right to appointment. I further understand that
appointment is subject to fulfillment of all conditions stipulated in the Notification.

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.
a. Region : PUDUCHERRY
b. Registration No. : 0162182
c. Next Renewal Date : 31/07/2013
18. Community : MBC - Origin
19. Category : Not Applicable
20. Examination Centre : PUDUCHERRY
21. Medium of Examination Opted : ENGLISH and TAMIL
22. Examination Fee :
Name of the Bank Amount Demand Draft Number Demand Draft Date
STATE BANK OF INDIA `50/- 262912 20/01/2014
23. Ration Card Number : 67388
24. EPIC / Voter ID Number : DNX0430876
25. Certificates :
Certificate Name Certificate Number Date Issued Taluk Office
PIC ----- ----- -----
Residence / Nativity 17116/top/c/10 20/07/2010 Taluk Office, Oulgaret
Caste 17116/top/c/10 20/07/2010 Taluk Office, Oulgaret
DATE: 21/01/2014
PLACE: PUDUCHERRY SIGNATURE OF THE APPLICANT
Note:
Unsigned application will be rejected.
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