Application Format

Application for the post of :

SCIENTIFIC ASSISTANT

1.
2.
3.
4.
5.
6.
7.

Name in full (in block letters)

:
Fathers Name
:
Date of birth
:
Sex
:
Nationality
:
Religion
:
Category(UR/SC/ST/OBC)
:
( Attach caste certificate in case of reserved Category):
8. Sub Category i.e. PH/EXS
:
(a) Specify Disability, if PH(OH/VH/HH)
(b) Percentage of Disability
(Attach attested copy of relevant certificate)
9. Complete address for communication with Pin Code :

10. Permanent Address in full with PIN Code

11. Educational / Technical Qualification

(indicate highest education qualification attained
And attach self attested copies of relevant certificate

THAKER SIDDHI ANILKUMAR

THAKER ANILKUMAR
15/02/1991
FEMALE
INDIAN
HINDU
UR

Photo
Attested by
a
Gazetted
Officer is to

NOT APPLICABLE

6, ODHAV KRUPA TENAMENTS,

SARU SECTION ROAD,
OPP. PALACE GROUND,
JAMNAGAR -361008

: 6, ODHAV KRUPA TENAMENTS,

SARU SECTION ROAD,
OPP. PALACE GROUND,
JAMNAGAR -361008
:

Examination Passed

Year

%of Marks

Subjects

Board/ University

S.S.C.

2006

72.71 %

G.S.H.S.E.B.

DIPLOMA IN
ELECTRICAL
ENGINEERING

2010

72.44%

MATHS, SCIENCE,
SOCIAL SCIENCE ,
ENGLISH,SOCIAL
STUDIES , GUJARATI
ELECTRICAL

BECHOLRES OF
SCICNE
(PHYSICS)

2015

78.40

12. Experience

PHYSICS,CHEMISTRY ,
MATHS,ENGLISH

TECHNICAL
EXAMINATIONS
BOARD ,
GANDHINAGAR
SAURASHTRA
UNIVERSITY

Organization /
Establishment Served
CHANGLA
INDUSTRIES
ISRO SAC,
AHMEDABAD

Post Held

Period
From - To
ELECTRICAL 01-07-2010 TO
SUPERVISOR 31-08-2011
TECHNICIA
13-09-2011 TO 12N
09-2012
APPRENTICE

DEV IMPEX

ELECTRICAL 01-09-2012 TO
SUPERVISOR 31-07-2013

Description of work
SUPERVISING OF ELECTRICAL
EQUIPMENTS
TESTING OF WIRING, THICKNESS
MESSUREMENT OF PLATING NAD
TO TAKE READINGS IN PHYSICAL
LAB
SUPERVISING OF ELECTRICAL
EQUIPMENTS.

13. Email ID and Mobile number for correspondence

: Mobile : +91 77 78 86 70 64
: Email : siddhithaker90@gmail.com

DECLARATION
1.

I fully understand that in the event of any information being found false or incorrect, appropriate
action can be taken against me.
2. Eligibility criteria will be verified on my appointment. If found ineligible, I understand that criminal
proceedings can be initiated against me for fraudulent entry and falsification of documents.
3. I hereby solemnly declare that all the statements made in the above application are true and correct.

Place

Date

Encl

(Signature of Candidate )
1. S.S.C. MARKSHEET
2. DIPLOMA MARKSHEET
3. B.Sc. (Physics) MARKSHEET
4. EXPERIENCE CERTIFICATE
5. LEAVING CERTIFICATE
6. PHOTO ID PROOF