Chennai Metropolitan Water Supply and Sewerage Board

Application Form

POST - ASSISTANT ENGINEER CIVIL / MECH.

Applicant Details : Applied On : 04/03/2017 20:55:01
REFERENCE ID. : CMWSSB053214

APPLICATION NUMBER : 153150

APPLICANT NAME : RAJKUMAR G

FATHER'S/HUSBAND'S NAME : GUNASEELAN V

MOTHER'S NAME : KRISHNAVENI G

DATE OF BIRTH : 29/05/1994

AGE OF APPLICANT : 23Years 1Months 3Days Affix your

recent passport size
PLACE OF BIRTH : SIVAKASI colour photograph

GENDER : MALE

NATIONALITY : INDIAN

RELIGION : HINDU

COMMUNITY : BC

STUDIED IN TAMIL MEDIUM : YES

CANDIDATE BELONGS TO : YES

TAMILNADU

DIFFERENTLY ABLED PERSON : NO

MOBILE NUMBER : 9655227150

E-MAIL ID : RAJKUMAR90137@GMAIL.COM

TEST LOCATION : MADURAI

DESTITUTE WIDOW : NO

EX-SERVICEMAN/ARMY PERSONNEL'S : NO
DEPENDENTS

PRIORITY DETAILS

COME UNDER PRIORITY : NO

PAYMENT DETAILS

PAYMENT MODE : ONLINE PAYMENT

PAYMENT TRANSACTION ID : 27352117 FEE AMOUNT : Rs. 500/-
PAYMENT DATE : 04/03/2017 PAYMENT STATUS : PAYMENT SUCCESS

PERMANENT ADDRESS CORRESPONDENCE ADDRESS

ADDRESS : 1012 ADDRESS : 1012

PKN ROAD PKN ROAD
SIVAKASI SIVAKASI
CITY : MADURAI CITY : MADURAI
STATE : TAMIL NADU STATE : TAMIL NADU
PINCODE : 626189 PINCODE : 626189
LANDLINE NO. :- LANDLINE NO. :-
EDUCATIONAL QUALIFICATION

Second Language in SSLC :

Second Language in PUC / HSC (+2) :
REQUIRED QUALIFICATION *
UNIVERSITY / MODE OF MONTH & PASS YEAR OBTAINED
QUALIFICATION MAX MARKS PERCENTAGE CERTIFICATE NO.
INSTITUTION STUDY (MM/YYYY FORMAT) MARKS
SSLC STATE BOARD REGULAR 05/2009 500 456 91.200 6574892
H.S.C (+2) DOTE REGULAR 04/2012 3700 3367 91.000 134897
B.E/ B.TECH/AMIE- ANNA
CIVIL ENGG UNIVERSITY REGULAR 04/2015 4800 3360 70.000 AUY1149287
CHENNAI

Other Details

Whether change of name made ? : NO

Are you employed in any other Govt. Dept. / Statutory Bodies / Public
: NO
Sector Undertakings
Is any Police cases pending : NO
Police cases details to come here :
information regarding arrest, convictions / debarment / disqualifications : NO
if yes details to come here :
NOTE: All relevant xerox copy along with original should be produced at the time of certificate verification.
DECLARATION
I hereby declare that all the statements made in this application are true andcomplete to the best of my knowledge and belief and nothing has
beenconcealed/distorted.I am aware that, if at any time I am found to haveconcealed/distorted any material information, my appointment is liable to
besummarily terminated without notice. Moreover, if any information is found incorrect/wrong, I shall be liable for action as decided by the
University authority.

Place:

(Signature of the Candidate)

Date: