Government of the People's Republic of Bangladesh

Bangladesh Public Service Commission

Applicant's Co
Application Form for Non-Cadre Examination [BPSC Form - 5 A]
Application for Ministry of Labour & Employment

User ID: NBFBJDESLI Ref: 68- 82/2018 | Last Date: 08 October 2018

Registration No 001759
Post Name Labour Inspector(safety)
Exam Centre DHAKA
Applicant's Name KAPIL CHANDRA BARAI
Father's Name KRISHNAKANTA BARAI
Mother's Name DIPALI BARAI
Date of Birth 1997-12-15 [YYYY-MM-DD] 20 Years 8 Months 18 Days
Gender Male

Freedom Fighter Status Non Freedom Fighter Ethnic Minority No

Marital Status Single Physically Handicapped No
Nationality/NID Bangladeshi/6001546594 Home District Gopalganj

Present Address: Permanent Address:

Care of: Krishnakanta Barai Care of: Krishnakanta Barai
Village/Town: Hiran Village/Town: Hiran
Post Office: Hiran Post Office: Hiran
Post Code: 8110 Post Code: 8110
Upazilla/Thana: Kotalipara Upazilla/Thana: Kotalipara
District: Gopalganj District: Gopalganj

Academic Qualifications:
Examination Board/Institute Group/Subject/Degree Result Year Roll Duration

S.S.C Dhaka Business Studies 4.56 2013 506651 N/A

Diploma Technical Business Studies 3.43 2017 727505 N/A

Enclosure: [Attested Certificates/Equivalent Certificates to be Submitted Later According to Tick Mark]

01. Recent Passpost Size Photograph 02. Admit Card

03. S. S. C. or Equivalent Certificate 04. H. S. C. or Equivalent Certificate

05. Graduation or Equivalent Certificate 06. Masters Degree or Equivalent Certificate

07. Diploma/Professional Certificate 08. Higher Degree Certificate

09. Experience/Membership Certificate 10. Research Papers

11. Birth Registration Certificate 12. National ID

13. Freedom Fighter Certificate 14. Ethnic Minority Certificate

15. Physically Handicapped Certificate 16. Others

I declare that the information provided in this form are correct, true and complete to the best of my knowledge and belief. If any information is found false,
incorrect, incomplete or if any ineligibility is detected before or after the examination, any action can be taken against me by the Commission including
cancellation of my candidature.
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