Application No: W0700095886 Application Form Anganwadi Worker

DEPARTMENT OF WOMEN & CHILD DEVELOPMENT AND SOCIAL WELFARE

MURSHIDABAD DISTRICT

Application Form for Direct Engagement to the Post of Anganwadi Worker.

Post and Residential Details:

Post applied for : Anganwadi Worker

Project Name : Domkal ICDS Project
Notification No. : 417/ICDS/DOM
Notification Date : 06/12/2022
Application Form Submitted On : 2022-12-30 16:23:10 from IP 42.105.192.172

Personal Details:

Applicant's Name * : Rashma Rahaman

Gender* : Female
Date of Birth* : 08/04/1987
Age : 34Years
Father's Name* : Md.Sahidur Rahaman
Mother's Name* : Suriya Begam
Husband's Nme* : Mobaidur Rahaman
Email ID* : rashma742133r@gmail.com
Mobile No* : 8373025746
Nationality* : Indian Marital Status* : Married

Permanent Address as per the Voter Card (EPIC)/ Electoral Roll or in absence of electoral data, as per certificate of appropriate
authority

Address : Vill+po-Dudhsar ps-Nowda Dist -Murshidabad

Village/Ward : Dudhsar
Block/Municipality : Domkal
Sub Division : Domkal Post Office: : Dudhsar
Police Station : Nowda Police Station District : Murshidabad
State : West Bengal Pin : 742174

Present Address:

Address : Vill+po-Dudhsar ps-Nowda Dist -Murshidabad

Village/Ward : Dudhsar
Block/Municipality : Domkal
Sub Division : Domkal Post Office : Dudhsar
Police Station : Nowda Police Station District : Murshidabad
State : West Bengal Pin : 742174

W0700095886 1/2
 W0700095886 2/2

Photo Identity Proof (Voter Card (EPIC)/ Authority of Certificate Issued): :

Voter Card No (EPIC No) : 000000000

Category Details:

Category : OBC-A Whether belongs to Exempted Category(EC)? : No

Certificate Number : 67968 Date of Issuance : 02/07/2014
Issuing District : Murshidabad

Disablity Details:

Whether Person with Disability

: No
(40% and above)?

Educational Qualification Details ( Madhyamik or Equivalent ):

Year of Passing : 2003 Name of the State where this Board is situated : West Bengal
Name of the Recognised Board
W.B.B.S.E

Highest Educational Qualification Details:

Qualification : Graduation Year of Passing : 2009

Name of the Board / Organization
University of Kalyani

Declaration:

I have studied the advertising notice thoroughly. I have also gone through the requirements for the post. I do hereby
declare that all statements made in this application are true, complete and correct to the best of my knowledge. In the
event of any information being found false or incorrect or ineligibility being detected before or after or during any stage of
selection process, appropriate action will be taken against me.

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