1/18/2020 Print Application Form

Print Application Form

(UTTAR PRADESH PUBLIC SERVICE

COMMISSION, PRAYAGRAJ)
उ र दे श लोक सेवा आयोग, यागराज
Detailed Application Form ( िव ृत आवेदन प )

✔ I declare that I have Read the detailed User Manual and Notification.

Notification Details ( Examination )

Advertisement Number : A-5/E-1/2019

Examination Name : Assistant Engineer (General/Special

Recruitment) Examination- 2019,

Apply for Examination : Assistant Engineer (General/Special

Recruitment) Examination- 2019,

Type of Recruitment : GENERAL RECTT.

Candidate's Personal Details

Registration No. 90300998815 Application ID : 214999903000111

:

Candidate's SHIVAM DOGRA Father's/Husband's SUKH DEV SHARMA

Name : Name :

Gender : Male Date of Birth : 24/07/1993

Domicile of UP : No Category : General

Are you No
Married?

Mobile Number : XXX-XXX-5761 Email-ID : ****hiv2018@gmail.com

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Bank Transaction Details

Payment State Bank Of India Payment Mode : INB

Gateway :

Fee Amount : Rs. 225.00 Transaction ID - IGAHXIGOS5 - 18/01/2020

Date:

Candidate's Other Details :

Are You State Govt. Employee of Uttar Pradesh Have you ever been Debarred from UPPSC ?:
? : No No

Are you an employee of Mandi Parishad / Mandi No

Samiti who has been separated from service Service Duration (Year-Month-Day) : 0 - 0 - 0
and who is covered by the order of Hon'ble
Supreme Court dated 16.12.2005 in Civil Appeal
No 4092/2001 State of U.P. Petitioner vs. Neeraj
Awasthi and Others ?

Have you already rendered one year's service No

or more in any of the Centralised Services or in Duration of Service (Year-Month-Day) : 0 - 0 - 0
the Nagar Nigam /Palika /Jal Sansthan /Jal KAl
Vibhag/Vikas Pradhikaran ? :

Do you want six year age relaxation in upper No

age for who was entitled in respect of his age to
appear at a selection in any year, in which no
selection is made(2013-2019), shall be deemed
to be entitled in respect of his age to apper at
the next following selection ?;

Do you want one year age relaxation in upper No

age for the post Assistant Engineer (Civil) of
Medical deptt., Assistant Engineer (Civil,
Mechanical) of Irrigation deptt. and Assistant
Engineer (Civil) the upper age limit in the case
of a candidate, who is trainee, shall be greater
by one year. ?

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High School & Intermediate Board,Year of passing & Roll Number Details :

Sr.No Examination Board Name Year of Passing Roll Number

Passed

1. High School HIMACHAL PRADESH BOARD OF 2008 1648616

SCHOOL EDUCATION

2. Intermediate HIMACHAL PRADESH BOARD OF 2010 2956754

SCHOOL EDUCATION

Essential Qualification Details

Sr Qualification Affirmation
No.

1 Till last date for submitting the applications, the candidates must possess Degree in any Yes
one of the following Branch awarded by an Institution or University established by law in
India.- (1) Civil Engineering. OR (2) Mechanical Engineering. OR (3) Agriculture
Engineering OR (4) Electrical Engineering OR (5) Chemical Engineering OR (6)
Industrial Engineering.

Have you a Diploma/Degree in Yes

Engineering :

Your Opted Engineering Branch Name : 05 - Electrical Engineering ( िवद् युत अिभयं ण )

Preferential Qualification Details

Sr.No. Qualification Acquired

1 A candidate who has (1) served in the Territorial Army for a minimum period of two No
years, or (2) obtained a "B" certificate of N.C.C. shall other things being equal, be
given preference in the matter of direct recruitment.

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Candidate's Address Details :

C/O- Name : SHIVAM DOGRA C/O SUKH House No. : 8

DEV SHARMA

Street No./PO : VILL BAAG PO DHANETA City Name : DHANETA

TEH NADAUN

State : HIMACHAL PRADESH District Name : HAMIRPUR

PIN : 177041

I accept the following declaration : : Yes

1. I hereby declare that I have read all terms & conditions according to the advertisement and I accept
it.

2. I hereby declare that all the entries/statements made in this application are true, complete and
correct to the best of my knowledge and belief.

3. I under take that if any information furnished or documents submitted by me are found to be false or
have been concealed, then my application/candidature is liable to be rejected/cancelled by UPPSC.

Current status of Application Form :

Your application is under processing.

Application Form Submission Date : 18/01/2020 , Application Form printing Date & Time : [ 18/01/2020 ,15:49:30
Time : 15:47:59 ]

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