ATTENDANCE SHEET

STAFF SELECTION COMMISSION (KKR), BANGALORE

(To be filled by the candidate)

1. Name of the Post / Examination :_____________________________

Affix Latest Passport Size
2. Name :__________________________________________ Photograph

3. Roll No : __________________________________________

4. Date of Birth : __________________________________________

5. Category :_________________ 5. OBC/SC/ST Certificate issued on : ________________

6. Date of Skill Test/DV : ____________ 7. Date of Passing Higher Secondary/Degree :______

7. Are you a Central Govt. Employee (Yes/No): _____________

(a) Date of Joining Service: _________ (b) Seeking Age Relaxation (Yes/No): _______

Signature of the Candidate : ______________________________

For Office Use Only
(Verification to be done with Original Application/Dossier/Commission’s Copy)

Please  Discrepancy, if any

Document Checked
YES NO NA
From Matriculation
Date of Birth
Certificate
From Original Degree/Marks
Essential Qualifications
Sheet
Cut-Off Marks From Original Marks Sheet Date of Issue:
Whether category
changed from OBC to UR
Category As claimed in the application
Reason for change of
category from OBC to UR
PH As claimed in the application

EXS As claimed in the application Date of Discharge:

Verified and signature

On-line Signatures
obtained

Preference For various Posts

Seeking Age
Relaxation as Certificate from Dept./Office
Central Govt. Emp.
Status of the candidate is ELIGIBLE/INELIGIBLE/PROVISIONAL
In case of any doubt/discrepancy, the same should be brought to the notice of AD/RD and get directions before the candidate is
permitted to appear for Skill Test/DV. Any undertaking given by the candidate also should be brought to the notice of AD/RD.

Date: Sign. of the Document Checker

The above candidate may be permitted to attend the Skill Test/DV. YES NO

Signature of AD