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Online Application Form

Post Details :
Advertisement No. * : 2/2013 Category No. * : 7 Name of Post * : Gram Sachiv

Personal Details (as per matriculation certificate) :

Candidate Name* Father's/Husband's Name* Mother's Name* : : :
nirmal kumar gurdev singh guddi devi 01/01/1994 20 Years 0 Months 18 Days

Date of Birth(dd/mm/yyyy)* : Age As On Eligibility Date.* :

Mailing Address :
Address* : City* : District* : State* : Pin Code* :
vpo mandheri tehsil shahabad kurukshetra Haryana 136136

Other Details :
Have you passed Hindi/Sanskrit upto Matriculation * : Nationality* : Sex* : Area* : Marital Status* :
Yes Indian

Male Urban

Female Rural Married Destitute BCA DFF BCB OSP Blind Non SBC No D&D EBPG

Un-Married Widow

Divorce No SC DESM No LowVision

Are you domicile of Haryana* : Category* : Are you Physical Handicap of Haryana* : Physical Handicap Sub-Category :

Yes General ESM Yes Ortho

Note : The candidates belonging to ESM/DESM/DFF/OSP/PHC will be required to select both the coloumns i.e. Category as well as caste which they belong. Are you employed in Govt /Public Sector Undertaking* : (If yes and you are in regular service then give details and have to submit NOC from the Employer at the time of interview) Contact Number* :
www.onlinehssc.in/ApplicationForm.aspx

Yes

No

8569926005

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Contact Number* : Email* : Confirm/Re-Enter Email* :

www.onlinehssc.in/ApplicationForm.aspx
8569926005 ns704648@gmail.com ns704648@gmail.com birth mark on right thigh SBP-State Bank of Patiala

Visible identification mark on the body of the candidate* : Select Bank Name for E-Challan* :

Education Qualification :
Examination Matriculation * Intermediate ITI/Vocational Diploma Graduation Post Graduation Other Qual. (If Any) Stream(i.e.10th /B.Sc/M.Sc/etc)
10th 12th

Board/ University
hbse hbse

Subject

Year Of Passing

Marks Obtained

Total Marks
500

Marks in %
69.20 76.00

Division (1/2/3)
1 1

hindi,english,math,sst,science,punjabi 2010 346

hindi,english,accunts,economics,business 2012 380 studies 500 Year Year Year Year Year

Reason For Gap ( If Any) :

Experience Details :
Organization Name Designation From Date To Date Total Exp. Nature of Duties Salary Per Month

Add More Experience

Documents Available With You In Support Of Your Eligibility For This Post :
Matriculation Certificate with Marksheet copy Graduation Degree with all Marksheets copy All Other Qualification Degree with all Marksheets copy Copy of Challan/E-Challan Haryana Resident Certificate Physically Handicap Certificate Note : All Document Must Be Issued Before Clossing Date of Advt. Intermediate Certificate with Marksheet copy Post Graduation Degree with all Marksheets copy Experience Certificate copy Caste Certificate ESM/ DESM/ DFF Certificate Gradation Certificate in case of OSP

Upload Photo & Signature :

If the Upload Photo / Signature is not loaded in appropriate place, your application is liable to get rejected Allowed Photo Size - 20KB to 50 KB File Type : *.jpge, *.gif Allowed Signature Size - 10KB to 20 KB File Type : *.jpge, *.gif Upload Photograph* : Upload Signature* :
Choose File No file chosen Choose File No file chosen

Declaration : I hereby declare that :1. All statements made in this application form are true, complete and correct to the best of my knowledge and belief. In the event of any information being found false or incorrect, or ineligibility being detected before or after the interview/appointment/selection, my candidature may be cancelled and action can be taken against me. I have read the provisions/instructions in advertisement of the Commission carefully and I hereby undertake to abide by them. I fulfill all the conditions of eligiblity regarding age limits, educational qualifications etc, prescribed in the advertisement and other relevant rules and instructions. I have never been convicted by Criminal Court.
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2.

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I agree.
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