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CommonRecruitmentProcess(CRP)forRecruitmentofProbationaryOfficer/Management

TraineesinParticipatingOrganizations(CWEPO/MTV)

RegistrationNumber

: 1410717485

FullName

: ANJALIBAJPAI

Category

: GENERAL

AreyouaPersonwithDisability

: YES

TypeofDisability

: HI

PercentageofDisability

: morethan40%

Areyousufferingfromcerebralpalsyandyourwritingspeedisaffected?

: NO

IfYes,Doyouneedcompensatorytimeatthetimeofexamination?

Whetheryourdominant(Writing)handisaffected?

: NO

IfYes,Doyouneedcompensatorytimeatthetimeofexamination?

Doyouintendtousetheservicesofascribe(onlyforVIcandidatesand
thecandidateswhosewritingspeedispermanentlyaffected)?

Areyouachild/familymemberofthosewhodiedin1984riots?

: NO

AreyouapersondomiciledintheStateofJammu&Kashmirduringthe
period111980to31121989?

: NO

AreyouanExServiceman

: NO

Actualservicerenderedindefenceserviceswhichmaybecountedfor
qualifyingasanExserviceman(InMonths):

Dateofrelieffromdefenceservices:

HaveyoujoinedaGovernmentjobonthecivilsideafteravailingofthe
benefitsgivenasanexserviceman?

Religiontowhichyoubelong

: Hindu

DoyoubelongtoReligiousMinorityCommunity?

: NO

WhetherservinginGovt./quasiGovt./PublicSectorUndertakings
(includingNationalisedBanks&FinancialInstitutions)?

: NO

HaveyouappearedfortheCWEPO/MTheldinyear2011?

: NO

RegistrationNo

HaveyouappearedfortheCWEPO/MTheldinyear2012?

: NO

RegistrationNo

HaveyouappearedfortheCWEPO/MTheldinyear2013?

: NO

RegistrationNo

HaveyouappearedfortheCWEPO/MTheldinyear2014?

: YES

RegistrationNo

: 1330709465

AadharCardNo.

Nationality/Citizenship

: Indian

State/UTtowhichcentreofexambelongs

: MadhyaPradesh

Statecode

: 30

CentreofExamination

: Jabalpur

ApplicationFee/Intimationcharges:
PaymentIn

: ONLINE

Amount

: 100.00

PaymentStatus

: PAID

ReferenceID

: DUTI3919379451

TransactionDate

: 22072015

PersonalDetails
DateofBirth

: 13081990

Agecompletedason01.07.2015

: 24

Gender

: FEMALE

MaritalStatus

: Unmarried

Father'sName

: RAVINDRANATHBAJPAI

Mother'sName

: LALITABAJPAI

Spouse'sName

AddressforCorrespondence

: HNO1063INFRONTOFGOVT
H.S.

Address2

: SCHOOLVEHICLEROAD
ADHARTAL

Address3

: JABALPUR

District

: JABALPUR

State

: MADHYAPRADESH

Pincode

: 482004

PermanentAddress

: HNO1063INFRONTOFGOVT
H.S.
: SCHOOLVEHICLEROAD
ADHARTAL
: JABALPUR

District

: JABALPUR

State

: MADHYAPRADESH

Pincode

: 482004

ContactDetails
MobileNo

: +918982319662

AlternativeNumber(MobileNo./LandlineNo.)

EmailID

: er.anjali.bajpai1990@gmail.com

QualificationDetails(ason01.08.2015)
ExamPassed

Degree

Subject/Stream

Dateof
Passing

%ofMarks

Graduation/Equivalent

B.Tech.

Engineering

29072011

79.20

PostGraduation

M.Tech.

Engineering

17122013

80.03

PGDCA

09052015

73.40

Others

DoyouhaveOperatingandworking
knowledgeincomputersystems?

: YES

DetailsofComputerKnowledge

: Diplomain

: ComputerOperations

OtherDetails
WhetherdesirousoftakingPreExam
Training(ApplicableonlyforSC/ST/
MinorityCommunity)

IfYes,CentreforTraining

OrganisationPreferencedetails:

1CanaraBank
2IndianOverseasBank
3UnionBankofIndia
4DenaBank
5SyndicateBank
6IndianBank
7BankofBaroda
8PunjabNationalBank
9AllahabadBank
10AndhraBank
11OrientalBankofCommerce
12UCOBank
13VijayaBank
14Punjab&SindBank
15BankofIndia
16BankofMaharashtra
17CorporationBank
18CentralBankofIndia
19BharatiyaMahilaBank

20IDBIBank
21UnitedBankofIndia
22EXIMBank
23ECGC
Whetheranyprosecution/detention/
fine/conviction/sentenceagainstyouhas
beenawardedbyanycourtoflawforany
offence?

: NO

Ifyes,particularsofthesame

LanguageDetails:

LanguagesKnown

Read

Write

Speak

HINDI

YES

YES

YES

ENGLISH

YES

YES

YES

Declarationforallthecandidates(OtherthanVIandOC)
IherebydeclarethatallthestatementsmadeinthisapplicationareTrue,CompleteandCorrecttothebestofmyknowledgeand
belief.IunderstandthatintheeventofanyinformationbeingfounduntrueorincorrectatanystageorIamnotsatisfyinganyofthe
eligibilitycriteriastipulated,andalsoincaseofcreatinginfluence/unduepressureregardingrecruitmentshalltantamounttocancellationof
mycandidature.

Date:21072015

SignatureofApplicant

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