Application For The Post of Assistants

http://www.hckrecruitment.nic.in/assistant2011/assistant_gen_2011/app_...

HIGH COURT OF KERALA APPLICATION FOR THE POST OF ASSISTANT

Recruitment No.8/2011

Paste here a passport size photograph(taken within the last six months)of the candidate.(Do not staple or pin)

Application Number : 18172 1. Name of the candidate 2. (a) Date Of Birth ANISHYADAS S V 03-05-1990 20 FEMALE

(The candidate should sign across the photograph pasted here)

(b) Age as on 1-1-2011 (c) Gender

3. (a) Religion (b) ReservationGroup (c) Caste 4. Mother Tongue 5. Are you a citizen of India ? 6. Name of Father 7. Address for Communication 8. Permanent Address 9. Mobile Number 10. Qualification Details ParticularsDegree/Diploma Bachelor's BE Degree

CHRISTIAN SIUC NADAR SIUC NADAR MALAYALAM YES Mr. SUMANADAS J DAS BHAVAN , KUTTANINNATHIL , THIRUVANANTHAPURAM , KERALA DAS BHAVAN , KUTTANINNATHIL , THIRUVANANTHAPURAM , KERALA 8547362824 THIRUPURAM P O P.O. , - 695133 THIRUPURAM P O P.O. , - 695133

Year of Subject-Main and Passing Subsidiaries

% of Marks Class/Grade for Optional University Subjects 77 ANNA UNIVERSITY

COMPUTER FIRST 2011 SCIENCE,MATHE CLASS MATICS,ELECTRONICS

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Application For The Post of Assistants

http://www.hckrecruitment.nic.in/assistant2011/assistant_gen_2011/app_...

11. Application Fee Details Demand Draft Amount Rs. Name of Bank Issuing Branch DD No DD Issue Date 12. Do you claim reservation of appointment in favour of SC/ST/OBC? 13. Do you claim relaxation of upper age limit? 14. Are you employed ? 15. Are you Physically Handicapped ? 200 STATE BANK OF INDIA KANJIRAMKULAM 588881 14-10-2011 YES NO NO NO

16. Have you been debarred from recruitment by Public Service Commission or dismissed from service or NO convicted by a Court of Law or are you facing any criminal prosecution ?

DECLARATION

I affirm that the foregoing information is correct and complete to the best of my knowledge and belief and that nothing has been concealed/distorted. If I am found to have concealed/distorted any material information, my appointment shall be liable to be summarily terminated.

Place: KUTTANINNATHIL Date: 17/10/2011

Signature of the Candidate

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