FILLED IN ONLINE APPLICATION FORM

FOR THE POST OF EXTENSION OFFICER GRADE-II (SUPERVISOR Gr.II) IN

WOMEN DEVELOPMENT AND CHILD WELFARE DEPARTMENT, TELANGANA

Application Number: 116239 Photo and Signature

Name of the Applicant: BANOTH SARADA
Father's/Husband Name: MALOTH SHANKAR
Date of Birth: 03/08/1986
Age as on (Should not have
Completed 50Years of age as on 29 years 5 months 0 days
01.01.2016):
Community: ST EWS: NA
District of your original Place of Employee
Kothagudem-Bhadradri Designation: AWT 122070097
Posting: ID:
Jagannadhapuram
Project: PALWANCHA (NEW) Sector: Janganadhapuram AWC:
-2
Name of the AWTC / MLTC / Poshan Abhiyan / MSK's: NA
malothshankar19
Aadhaar Number: 271190013933 Mobile: 8328093691 Email ID:
@gmail.com
Educational Qualification of the Year of
Bachelor’s Degree Roll No: 182062024 2010
Applicant: Passing:
12 years 4 months
Date of entry into service 26/02/2009 Total years of service completed as on 01-07-2021
5 days
Balasevika Trained: No
Are You Differently Abled
No Disablity: NA
Person?
Percentage of Disability as per
NA
SADAREM Certificate:
Payment TransactionID: WHD40429965826 Date: 23/11/2021 03:06:59 PM Amount: 200.00
Application Submitted on: 23/11/2021 03:31:58 PM
Self Declaration by Candidate
I, hereby declare that I have completed required qualification as per notification.
I, hereby declare that I have completed 10 years of continuation services as AWT/Contract Supervisor or I have completed 5 years of
continuation service as Instructor/Coordinator.
I, hereby declare that all the information submitted by me in the application form is correct, true and valid as per my best of knowledge. I
will present the supporting documents in original as and when required.

( Signature of the Applicant)

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