Application Form

Panchayti Raj Department, Govt. of Bihar

Application for Recruitment
Application Details
Application ID :     TAT/0096105 Application Date : 27-Sep-2018 Post Applied For : Technical Assistant
Personal Details
Applicant Name : PRASHANT KUMAR JHA
Father's /Husband's Name : BADSHAH JHA
Date of Birth : 09-Jun-1995
Age on (01.08.2018) : 23 Years 1 Months
Gender : Male
Category : GEN
Nationality : Indian
Email ID : Pbjha02@gmail.com
Mobile No. : XXXXXXX4415
Aadhar Type
Phone With STD Code :
Physically Handicapped No
Grand Children of Freedom Fighter No

Address for Correspondence

Address : At+ Po-Bambaiya Harlal Ps-Dalsinghsarai Dist-Samastipur Bihar
Pin Code : 848114

Permanent Address
Address : At+ Po-Bambaiya Harlal Ps-Dalsinghsarai Dist-Samastipur Bihar
Pin Code : 848114
State of Domicile : Bihar
Home District : SAMASTIPUR
Choice District : SAMASTIPUR

Educational Qualification
  Board/University Specialization State Whether Passing Marks Full Marks Marks
Government or Year Obtained (Excluding Obtained
Private (Excluding Extra  (%)
Extra Subject)
Subject)
I.Matric BSEB PATNA Bihar Government 2012 282 500 56.4
II.Intermediate/12th BSEB PATNA Science Bihar Government 2014 319 500 63.8
IV.Diploma SBTE Diploma in Jharkhand Government 2018 1238 1775 69.75
JHARKHAND Civil
Engineering
V.Additional 0 0 0 0
Qualification

I declare that all the above information is correct to the best of my knowledge and that I shall be liable for punishment if
any information is found incorrect. I also declare that I have understood the guideline for engagement and will fully abide
by the same including any future guideline issued by Panchayti Raj Department in this regard.

Place:-

Date:-
Signature of Applicant