APPLICATION FOR WEST BENGAL CIVIL SERVICE (EXE.) ETC. EXAMINATION, 2020 (ADVERTISEMENT NO.

22/2019)

REGISTRATION NO: PSCWB05529449205 PAYMENT ID: CPSC5529449041c9

Enrolment No: PSC05183357

Candidate Name: ROUNAK BASU
Father's Name: SHAILENDRA NATH BASU
Mother's Name: SUMANA BASU
Place of Birth: HOWRAH
Do you have ability to read, write and YES
speak in Bengali:
Whether you are a Nepali Speaking NO
person:
State your mother tongue: Bengali
Date of Birth: 17. January .1993
State your choice of language in Bengali
compulsory Paper - I:

Sex MALE Physically Challenged: NO

Whether a citizen of India YES Meritorious Sportsperson NO
(Only for posts under Group D):
State, whether a natural citizen or a citizen By Birth
by registration : Email Id: rounakbasu93@gmail.com
Category General

Address For Correspondence Permanent Address

Address : North Podra Address : North Podra
CHANDRABATI VILLAGE ROAD CHANDRABATI VILLAGE ROAD

State: West Bengal State : West Bengal

District : Howrah District : Howrah
Pin: 711109 Pin: 711109
Mobile No. 9038434800 Mobile No. 9038434800

Academic Qualifications (Madhyamik or equivalent and onwards)

Examination Exam / Course Year of Passing Name of Board/Council/U Subjects Taken Division/Cl Marks % Remarks
niversity ass/Grade
Class 10th or eq Madhyamik 2008 WBBSE General 1st 85 Star
uivalent
Class 12th or eq
HS 2010 WBCHSE Science 1st 70.8
uivalent
Graduation (Bac B.Tech 2014 WBUT Mechanical Engineering 1st 67.7
helor Degree)
MBA MBA 2017 IIEST Shibpur Operations & Marketing 1st 61

Whether having experience ? YES

Name of the Post Temporary/Permanent/on Office where employed Date of joining Date of leaving Cause of leaving
Contract basis
Trainee Engineer Contractual Essar Steel 3rd Party 01/08/2014 31/07/2015 Higher Education
Asst Professor Contractual Seacom Management College 01/08/2017 31/07/2019 Betterment

Center Preference(Preli.)
Preference Howrah

Information related to Group(s) opted for

Group(s) opted for Group 'A',Group 'C',Group 'D'

Group(s) not opted for Group 'B'

Optional Paper : Management

I solemnly declare that :

a) I am eligible to apply for the examination as per the notification.
b) All statements made in this application are true, complete and correct.
c) Original documents will be produced on demand.
d) I agree to take this examination on the condition that the Commission may cancel my candidature if at any stage I am
found ineligible.

I have obtained all my certificates (Qualification, Disability Certificate and/or Caste) within the date of submission of my
application.
I have informed the Head of my Office or Department in writing that I am applying for this examination (Please click the box if you are in service of Govt. or Local or Statutory Body).
I agree that all the information provided here, are correct according to my knowledge

PLEASE REVIEW THE ABOVE DETAILS CAREFULLY FOR ANY ERRORS BEFORE CONFIRMING SUBMISSION.

CAUTION
A candidate must consult the "Advertisement" and Scheme & Syllabus available with the advt. in the
Commission's website and fill in the application correctly. applications once submitted shall be treated as
final. No request for change in application form and no claim for being a member of the SC, ST and BC (Non-
Creamy Layer) community will be entertained after the submission of application.

THE FORM WOULD BE CONSIDERED SUCCESSFULLY SUBMITTED ONLY AFTER PAYMENT OF EXAMINATION
FEE ( IF APPLICABLE)
PLEASE DOWNLOAD YOUR ADMIT CARD BEFORE EXAMINATION
Date : 25-11-2019
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