OnlineRecruitmentPortal RSMSSB

1.RecruitmentDetails

RecruitmentName RecruitmentforJEN(CIVILANDMECHANICAL)2016

PostApplied JENNonScheduled

ApplicaonNo. 201600067874

ApplicaonSubmiedDate 14Jul201612:16:07AM

2.Applicant'sDetails

CandidateName KAPILKUMARGAUTAM Father'sName PAWANKUMAR

Mother'sName MADHUBALASHARMA Gender Male

DateofBirth 16Jul1993 Category GENERALOBCSBC(CREAMY)

SpeciallyabledCategory NotApplicable Religion HINDU

MaritalStatus Single SpouseName NA

MarriageReg.No NA Mobile 9783898826

Email er.kapilgautam@gmail.com AadharId 469021976368

No.OfLivingChild(Bornbefore01/06/2002) Bhamashah NA 0

0 0

ApplyingFor

Applyingfor JENCivilDegree

CorrespondanceAddress

NEAROLDAGEHOME,NAINWA
AddressLine1 PLOTNO71,KUNJVIHARCOLONY AddressLine2 ROAD

AddressLine3 BUNDI State Rajasthan

District BUNDI City/Village BUNDI

PinCode 323001 PhoneNo. 9783898826

PermanentAddress

NEAROLDAGEHOME,NAINWA
AddressLine1 PLOTNO71,KUNJVIHARCOLONY AddressLine2 ROAD

AddressLine3 BUNDI State Rajasthan

District BUNDI City/Village BUNDI

PinCode 323001 PhoneNo. 9783898826

3.PersonalDetails

Naonality Indian HomeState Rajasthan

HomeDistrict BUNDI Tehsil/City Bundi

Village NA SeledinIndiafromOtherCountry No

FromWhichCountry NA

SpecialCategory

AreYouExprisoner? No TimeofPrisonment(Inmonths) NA

AreyouNCCCadetinstructor? No Duraon(Inmonths) NA

AreYouExServiceman? No DepartmentName NA

OutstandingSportsPersons? No SportPersonType NA

ExisngGovtDept/PubicUndertaking
Employee? No DepartmentName NA

ExisngStateGovernmentEmployee
(Substanve)? No DepartmentName NA

4.EducaonQualicaonDetails
Nameof Yearof
SNo. NameofExam RollNo. Result Percentage/Grade
Board/University/School Passing
1 Secondary RBSE 0192436 2007 Percentage 72.33
2 Secondary RBSE 0192436 2007 Percentage 72.33
3 Sr.Secondary/Equivalent RBSE 1164531 2009 Percentage 79.08
4 Sr.Secondary/Equivalent RBSE 1164531 2009 Percentage 79.08
5 BE/B.tech MPUAT 3512 2014 CGPA 7.38
6 BE/B.tech MPUAT 3512 2014 CGPA 7.38
Debarrded

HasanyBoard/CommisionDebarredyouforuseofunfairmeansetcinit'sCompetve/RecruitmentExam? No

NameofBoard/Commision NA OrderNumber NA

OrderDate NA NameOfExam NA

PeriodForWhichdebarred(In
ExamDate NA Months) NA

Hastheperiodofdebarofexpired? No

5.FeeStatus

FeeSubmied

PaymentMode ONLINE Amount 660

PaymentStatus SUCCESS ReceiptNo 1699099911085403

TransaconDate 14Jul201612:16:07AM

6.Declaraon
6.Declaraon
Iherebydeclarethatallinformaongiveninthisapplicaonformaretrueandcorrecttothebestofmyknowledgeandbelief.Informaonlike
Namefathernamemothernamehusbandnamedateofbirthcategoryphotosignaturemobilenumberetc.hasbeenveriedandIamcompletely
sasedbytheselleddetailsintheapplicaonform.Iwillberesponsibleincaseofanymistakefoundinmyapplicaonform.Intheeventofmy
informaonbeingfoundfalseorincorrectortheineligibilitybeingdetectbeforeoraerthewrientestaconcanbetakenagainstmebythe
competentauthority.IhavereadtheprovisionsoftherelevantrulesandtheadversementcarefullyandIherebyundertaketoabidebythem.I
furtherdeclarethatIfulllallthecondionsofeligibilityregardingtheagelimitseducaonqualicaonetc.prescribedforadmissiontothewrien
test.

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KAPILKUMARGAUTAM