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GOVERNMENT OF ASSAM

STATE LEVEL POLICE RECRUITMENT BOARD, ASSAM


REHABARI::: GUWAHATI

(NO APPLICATION FEE IS APPLICABLE)

APPLICATION FORM
SLPRB/REC/FOREST/GD-III/1081/2020/179 APPLY DATE: 09-JUN-2020

APPLICATION NO. NAME: DATE OF BIRTH:


NEW : FRST1178839 MOIDUL ISLAM 06-02-1995

FATHERS' NAME: MOTHERS' NAME: CASTE:


MOHI UDDIN SARKAR NURIMA BEGUM GENERAL

EMAIL: PHONE: ADD. PHONE: GENDER:


ISLAMMUHAMMADMOIDUL@GMAIL.COM 6002393278 8011185324 MALE

NATIONALITY: RELIGION: EMPLOYMENT NO. :


INDIAN ISLAM 554/2017

POST APPLIED FOR :


FORESTER-I (PREFERENCE 1)
FOREST GUARD (PREFERENCE 2)

PERMANENT ADDRESS CORRESPONDENCE ADDRESS

VILL:- URAR BHUI. P/O:- RADHAMADHOB HAT. VILL:- URAR BHUI. P/O:- RADHAMADHOB HAT.

DISTRICT: POLICE STATION: PIN: DISTRICT: POLIOCE STATION: PIN:


SOUTH SALMARA MANCACHAR 783131 SOUTH SALMARA MANCACHAR 783131

ACAMEDIC QUALIFICATION

COLLEGE NAME: QUALIFICATION: DEPARTMENT: PERCENTAGE:


MANKACHAR COLLEGE GRADUATE BA 57.58 %

EXTRA CURRICULAR ACTIVITIES

ELEPHANT
STENOGRAPHY DRAFTSMAN DRIVING
UPKEEPING CARPENTRY CERTIFICATE NCC CERTIFICATE
CERTIFICATE CERTIFICATE CERTIFICATE
CERTIFICATE
NA NA
NA NA NA
NA

COMPUTER HOME GUARD SPORTS EMPLOYMENT EXCHANGE


EWS CERTIFICATE EX-SERVICEMAN CERTIFICATE
CERTIFICATE CERTIFICATE CERTIFICATE CERTIFICATE
NA NA
NA NA NA YES

DECLARATION:
It is certified that above particulars are true to my knowledge and belief. Further, I understand that if any of the above particulars is found false, my
candidature will be automatically rejected.

NOTICE:
Candidate should check all the data entered in the application form very carefully. Any issue noticed, candidate may contact recruitment Help Desk Tel: 7636071991, 7636071992, 7636071993 (09:00am -
06:00pm) or Email: slprbrect@gmail.com.

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