GOVERNMENT OF PUDUCHERRY

Department of Revenue and Disaster Management

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Application for Recruitment to the post of VILLAGE ADMINISTRATIVE OFFICER
(Pay Band - 1: `5200-20200 with Grade Pay: `2400/-)
17629
POST APPLIED
Name of the Post Code Number
VILLAGE ADMINISTRATIVE
OFFICER
01
Applicant's Specimen Signature:
1. Application Number : 17629
2. Name of the Applicant : Mr. RADHAKRISHNAN A
3. Father's Name : ARUMUGAM
4. Mother's Name : LAKSHMI
5. Spouse's Name (if married) : PREMILADEVI
6. Date of Birth : 21/04/1988
7. Age as on 22/01/2014 : 25 years and 9 months
8. Gender : Male
9. Address :
Address for Communication Permanent Address
NO. 13, SK STREET
KONERIKUPPAM
KOODAPAKKAM
PUDUCHERRY - 605502
NO. 13, SK STREET
KONERIKUPPAM
KOODAPAKKAM
PUDUCHERRY - 605502
10. Mobile Number : +919786484828
11. E-Mail Id : krish.radha21@gmail.com
12. Educational Qualifications :
Sl.
No.
Qualification Name of the Board
Month & Year
of Passing
1 SSLC or equivalent STATE BOARD OF TAMILNADU Mar, 2005
2
H.Sc / 3 years Diploma or
equivalent
DIRECTORATE OF TECHNICAL
EDUCATION
Apr, 2011
13. Technical Qualifications :
Name of the
Course
Duration of Course
(in Months)
Month & Year of
Passing
Name of the
Institution
Wether recognized
by Government
DCA 3 Jul, 2005
RV COMPUTER
EDUCATION
Yes
14. Nationality : INDIAN
15. Whether Native / Resident of
Puducherry
: Yes
16. Religion : HINDU
17. Have Regd in Emp Exchange? : No
18. Community : MBC - Origin
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6.

DECLARATION

I have read the provisions in the Notification of the examination carefully and hereby undertake to abide
by them.

I declare that I am a Native / Resident of Union Territory of Puducherry by virtue of continuous
residence for the last five years immediately preceding the date of Notification and I understand that any
deviation in this regard will render my selection invalid.

I have not submitted any other application for this examination. I am aware that if I contravene this, my
application will be summarily rejected.

I further declare that I fulfill all the conditions of eligibility regarding age limits, educational
qualification, technical qualification etc., prescribed for admission to the examination.

I also declare that I have never been convicted by any court of law. I also declare that no charge sheet is
pending against me in any court of law.

I understand that success in examination confers no right to appointment. I further understand that
appointment is subject to fulfillment of all conditions stipulated in the Notification.

I hereby declare that all statements made in this application are true, complete and correct to the best of
my knowledge and belief. I understand that in the event of any information being found suppressed / false or
incorrect or ineligibility being detected before or after the examination, my candidature / appointment is
liable to be cancelled.
19. Category : Not Applicable
20. Examination Centre : PUDUCHERRY
21. Medium of Examination Opted : ENGLISH and TAMIL
22. Examination Fee :
Name of the Bank Amount Demand Draft Number Demand Draft Date
SBI `50/- 539743 26/12/2013
23. Ration Card Number : 360466
24. EPIC / Voter ID Number :
25. Certificates :
Certificate Name Certificate Number Date Issued Taluk Office
PIC ----- ----- -----
Residence / Nativity ----- ----- -----
Caste ----- ----- -----
DATE: 12/01/2014
PLACE: PUDUCHERRY SIGNATURE OF THE APPLICANT
Note:
Unsigned application will be rejected.
17629 | 12/01/2014 09:25:20 AM Page 2 of 2