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Application Form

Panchayti Raj Department, Govt. of Bihar


Application for Recruitment
Application Details
Application ID :     TAT/0016307 Application Date : 06-Sep-2018 Post Applied For : Technical Assistant
Personal Details
Applicant Name : MURARIKUMAR
Father's /Husband's Name : SHYAMNANDANRAY
Date of Birth : 27-Jul-1994
Age on (01.08.2018) : 24 Years 0 Months
Gender : Male
Category : GEN
Nationality : Indian
Email ID : Raymurari6857@gamil.com
Mobile No. : XXXXXXX6857
Aadhar Type Aadhar No
Aadhar No XXXXXXXX5609
Phone With STD Code :
Physically Handicapped No
Grand Children of Freedom Fighter No

Address for Correspondence


Address : Village-Bakhari, Post Office-Janardanpur, Block-Kalyanpur, Dist-Samastipur, State-
Bihar
Pin Code : 848302

Permanent Address
Address : Village-Bakhari, Post Office-Janardanpur, Block-Kalyanpur, Dist-Samastipur, State-
Bihar
Pin Code : 848302
State of Domicile : Bihar
Home District : SAMASTIPUR
Choice District : SAMASTIPUR

Educational Qualification
  Board/University Specialization State Whether Passing Marks Full Marks Marks
Government Year Obtained (Excluding Obtained
or Private (Excluding Extra  (%)
Extra Subject)
Subject)
I.Matric B.S.E.B Bihar Government 2010 333 500 66.6
II.Intermediate/12th B.S.E.B Science Bihar Government 2012 324 500 64.8
IV.Diploma STATE COUNCIL FOR Diploma in Assam Government 2015 1522 2400 63.42
TECHNICAL EDUCATION, Civil
ASSAM Engineering
V.Additional 0 0 0 0
Qualification

I declare that all the above information is correct to the best of my knowledge and that I shall be liable for punishment if
any information is found incorrect. I also declare that I have understood the guideline for engagement and will fully abide
by the same including any future guideline issued by Panchayti Raj Department in this regard.

Place:-

Date:-
Signature of Applicant

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