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TNPSC

TamilNaduPublicServiceCommission

Name o f th e P o st Ap p l yi n g fo r / :

VIL L AGE ADMINIST RAT IVE OFFICE RINT HE T AMIL NADU

MINIST E RIAL SE RVICE

No ti fi c ati o n No . / : 1 9 / 2 0 1 5
Ap p l i c ati o n No . / : 5 1 9 0 1 2 9 0 7
Reg i strati o n Date :/ : 1 3 1 1 2 0 1 5 1 2 :4 0 :2 6

Name o f th e Can d i d ate/ :

In i ti al s

Name

L AKSHMANAN

Gen d er/ : MAL E

Date o f Bi rth / : 0 3 0 3 1 9 8 8

Fath er' s Name/ :

Mo th er' s Name/ :

In i ti al s

Name

MANI

In i ti al s

Name

SHANT HI

Mari tal S tatu s/ ? UNMARRIE D

Can d i d ate' s P l ac e o f Bi rth / : VE L L ORE
Nati ve Di stri c t/ : VE L L ORE
Fath er' s P l ac e o f Bi rth / : VE L L ORE
Mo th er To n g u e/ : T AMIL
Nati o n al i ty/ : INDIAN
Rel i g i o n / : HINDU

CertificateDetails /
Co mmu n al Categ o ry/ : B ACKWARDCL ASS(B C)
Name o f th e S u b Caste/
:

Certi fi c ate No /
:

Date o f Issu e/
:

Issu i n g Au th o ri ty/

VANIACHE T T IARINCL .GANDAL A

/ GANIKA/ T E L IKUL A/
999445
0 5 0 5 2 0 0 2

DE PUT YT ASHIL DAR

(CE RT IFICAT E )

Di stri c t/ :

VE L L ORE

Tal u k/ :

VE L L ORE

Are yo u a Di fferen tl y Ab l ed P erso n / ? NO

Are yo u a Go vern men t E mp l o yee/ ? NO
Have yo u b een d eb arred o r d i sq u al i fi ed b y th e P u b l i c S ervi c e
Co mmi ssi o n o r an y o th er rec ru i ti n g ag en c y fro m ap p eari n g
exami n ati o n s an d sel ec ti o n s fo r sp ec i fi c p eri o d o r p erman en tl y? /

NO

Are yo u an E xS ervi c emen / ? NO

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TNPSC
Cri mi n al Case Reg i stered / ? NO
P arti c i p ati o n i n P o l i ti c al Ac ti vi ti es / ? NO

CommunicationDetails /
Co rresp o n d en c e Ad d ress/

P erman en t Ad d ress/
Ad d ress Li n e 1 / 1 : 7 / 4

Ad d ress Li n e 1 / 1 : 7 / 4

VE NGAPPACHE T T Y
ST RE E T

Ad d ress Li n e 2 / 2 : VE NGAPPACHE T T YST RE E T

Ad d ress Li n e 2 / 2 :

Ad d ress Li n e 3 / 3 : VE L L ORE

Ad d ress Li n e 3 / 3 : VE L L ORE

S tate/ : T AMIL NADU

S tate/ : T AMIL NADU

Di stri c t/ : VE L L ORE

Di stri c t/ : VE L L ORE

P i n c o d e/
: 6 3 2 0 0 4

P i n c o d e/
: 6 3 2 0 0 4

E mai l ID/ : l a kshma na n2 3 rec@g ma i l .co m

Mo b i l e No / : 9 9 4 4 9 2 8 1 6 9

EducationalQualificationParticulars /
S S LC
Date o f Resu l t P u b l i sh ed / :

2 5 0 5 2 0 0 3

Name o f th e Bo ard / Un i versi ty / / :

MAT RICUL AT ION

Certi fi c ate Nu mb er/ :

0065612

Wh eth er stu d i ed Tami l as o n e o f th e su b jec t/

?

Med i u m o f In stru c ti o n / :

YE S
E NGL ISH

HS C
Date o f Resu l t P u b l i sh ed / :

1 7 0 5 2 0 0 5

Med i u m o f In stru c ti o n / :

E NGL ISH

Name o f th e Bo ard / Un i versi ty / / :

MAT RICUL AT ION

Certi fi c ate Nu mb er/ :

1663928

Wh eth er stu d i ed Tami l as o n e o f th e su b jec t/

?

YE S

U n d erGrad u ate
Date o f Resu l t P u b l i sh ed / :

0 9 0 6 2 0 0 9

Name o f th e Deg ree / :

B ACHE L OROFE NGINE E RING

Majo r S u b jec t/

COMPUT E RSCIE NCE

Name o f th e Bo ard / Un i versi ty / / :

ANNAUNIVE RSIT Y

Certi fi c ate Nu mb er/ :

H4 3 0 2 6 2

Wh eth er stu d i ed Tami l as o n e o f th e su b jec t/

?

Med i u m o f In stru c ti o n / :

NO
E NGL ISH

Pos tGrad u ate

Date o f Resu l t P u b l i sh ed / :

0 3 0 7 2 0 1 1

Name o f th e P G Deg ree / :

MAST E ROFE NGINE E RING

Majo r S u b jec t/ :

COMPUT E RSCIE NCE

Name o f th e Bo ard / Un i versi ty / / :

ANNAUNIVE RSIT Y

Certi fi c ate Nu mb er/ :

B D7 7 8 7 8

Wh eth er stu d i ed Tami l as o n e o f th e su b jec t/

?

Med i u m o f In stru c ti o n / :

NO
E NGL ISH

ExperienceDetails /
Name o f th e Org an i sati o n ( s) /

Desi g n ati o n /

P eri o d Fro m/

P eri o d To /

Natu re o f Du ty/

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TNPSC
T HE KAVE RYE NGINE E RING
COL L E GE

ASST .
PROFE SSOR

2 8 0 6 2 0 1 1

Do yo u h ave th e P h ysi c al S tan d ard s as p er n o ti fi c ati o n ? /

? :

1 3 1 1 2 0 1 5

T E ACHING

YE S

ExaminationParticulars /
Name o f th e E xami n ati o n Cen tre/ : VE L L ORE
S u b jec t( s) fo r E xami n ati o n / :

GE NE RAL ST UDIE SWIT HB ASICSOFVIL L AGE ADMN.AND

GE NE RAL E NGL ISH(SSL CST D.)

RegistrationFees
* P aymen t Mo d e NIL

FeeConcession /
** Do yo u c l ai m exami n ati o n fee c o n c essi o n ? /

? :

YE S

Declaration /
I h ereb y d ec l are th at al l th e p arti c u l ars fu rn i sh ed i n th i s ap p l i c ati o n are tru e, c o rrec t an d c o mp l ete to th e b est o f my kn o wl ed g e an d b el i ef.
In th e even t o f an y i n fo rmati o n b ei n g fo u n d fal se o r i n c o rrec t o r i n el i g i b i l i ty b ei n g d etec ted b efo re o r after th e exami n ati o n , ac ti o n c an b e
taken ag ai n st me b y th e TNP S C.
, .


.

I h ereb y d ec l are th at I wi l l n o t b e a p arty to an y ki n d o f c an vassi n g o n my b eh al f.

.

I fu rth er d ec l are th at I fu l fi l al l th e el i g i b i l i ty c o n d i ti o n s p resc ri b ed fo r ad mi ssi o n to th e exami n ati o n .

.

I h ave g o n e th ro u g h th e i n stru c ti o n s to th e c an d i d ates an d th e Co mmi ssi o n ' s n o ti fi c ati o n fo r th i s Rec ru i tmen t b efo re fi l l i n g u p th e
ap p l i c ati o n fo rm.
" "
.

I d ec l are th at I p o ssess th e P h ysi c al stan d ard s p resc ri b ed fo r th e p o st( s) wh i c h I am n o w ap p l yi n g .

.

I Certi fy th at I h ave n o t b een d eb arred / d i sq u al i fi ed b y th e TNP S C o r an y o th er rec ru i ti n g ag en c y.

.

I am n o t a d i smi ssed Go vern men t E mp l o yee.

.

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