|| ON-LINE APPLICATION FORM ||
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Post Applied For
:
Advt. No 07/2010 dt 15/05/2010
Personal Details
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Name of the Applicant :
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Mr.
Miss.
Mrs.
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Father's Name :
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Mr.
Late.
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Mother's Name :
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Mrs.
Late.
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Permanent Address :
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Postal Address for Communication :
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Date of Birth :
Day
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Month
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Year
Age :
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Sex :
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Male
Female
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Category :
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Others
SC
ST
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Contact Telephone Number :
Land Line :
(if no, quote'0')
Mobile :
(if no, quote' 0')
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Whether Differently abled (PH) :
(at least 40% disability)
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Yes
No
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In case of ST/SC, whether the certificate has been issued by Appropriate Authority of the Govt. of Tripura :
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Yes
No
Educational / Other Qualifications Details
Essential : Bachelors Degree (or equivalent) in Science or Engineering with at least 1 (one) of the subjects as mentioned in the Advertisement.
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Name of the Examination :
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Name of the Elective Subject :
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Name of the University :
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Year of Passing :
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Percentage of marks obtained :
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Any other Qualifications suitable for the post :
Subjects / Papers Details for appearing in the Competitive Examination
Compulsory Paper-I :
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Optional Paper-I :
Compulsory Paper-II :
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Optional Paper-II :
Miscellaneous Details
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Minimum Physical Standard as per the Advertisement :
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Yes
No
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Whether currently employed in regular Govt. Service :
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Yes
No
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Whether Ex-Serviceman :
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Yes
No
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If yes, period of Service :
(years)
(if no, quote'0')
(months)
(if no, quote'0')
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Experience, if any :
Desirable :
Knowledge of Bengali :
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Yes
No
Bank Details
Recruitment Fee Deposited in the Account No.
14711
of the Tripura Gramin Bank or
31110220136
of the State Bank of India in favour of
The Secretary, Tripura Public Service Commission, Agartala.
Deposited through
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Bank Name :
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Branch Name :
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Fee Deposit Date :
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Amount
(Rs.)
:
Declaration
I declare that the information given is correct to the best of my knowledge. My candidature is liable to be rejected at any stage of recruitment process or after recruitment or joining if any information provided by me is found false or is not found in conformity with eligibility criteria mentioned in the Advertisement
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