EMPLOYEES’ STATE INSURANCE CORPORATION 160144

RECRUITMENT OF GROUP ‘C’ PARAMEDICAL POSTS

Registration Number : 258037766

Full Name : AJRUDDIN ALI

Post : Pharmacist (Allopathic)

Region : Delhi NCR

Category : OBC

Are you a person with benchmark disability : NO

of 40% and above ?

Disability category : -

Type of Disability : -

Do you need compensatory time at the time : -

of examination?

Are you suffering from cerebral palsy and : -

your writing speed is affected?

If Yes, Do you need compensatory time at : -

the time of examination?

Whether your dominant (Writing) hand is : -

affected?

If Yes, Do you need compensatory time at : -

the time of examination?

Do you intend to use the services of a : -

scribe ?

Are you a person with specified disability : NO

covered under the definition of sec 2(s) of
the RPwD Act, 2016 and not covered under
sec 2(r) of the said act and having difficulty
in writing?

If Yes, Do you need compensatory time at : -

the time of examination?

Are you a person with specified disability : -

covered under the definition of sec 2(s) of
the RPwD Act, 2016 and not covered under
sec 2(r) of the said act and wish to avail the
services of Scribe?

I certify that, I will produce the certificate : -

from competent medical authority of a
Government healthcare institution as per
Ministry of Social Justice and
Empowerment, Department of
Empowerment of Persons with Disabilities
(Divyangjan) circular no F. No. 29-6/2019-
DD-III dated 10.08.2022.

Whether scribe will be brought by candidate : -

?

Do you need scribe from Employees’ State : -

Insurance Corporation ?

Do you belong to Religious Minority ? : NO

Are you ESIC Employee/ Government : NO

Servant who have rendered not less than 3
years regular and continuous service as on
closing date for receipt of application : ?

Kindly Specify : -

Are you a regular ESIC employee seeking : -

relaxation in fee ?

Are you an Ex-Serviceman : ? : NO

Period of Service ( in months) : -

Ex-Servicemen who have already secured : -

employment in civil side under Government
in Group ‘C’ & ‘D’ posts on regular basis
after availing of the benefits of reservation
given to ex-servicemen
Any other category for relaxation in age : NO

Mention category for age relaxation : -

Nationality : Indian

State/UT to which centre of Online : Uttar Pradesh

examination belongs
Centre of Online Examination : Gorakhpur

Application Fee / Intimation charges

Payment In : ONLINE

Amount : 500.00

Payment Status : PAID

Reference ID : YHD42105493228

Transaction Date : 09-10-2023

Do you want to receive refund of fees in the : -

same channel by which you are paying fees
?

Account Number : -

Account Type : -

Bank Name : -

Branch Name : -

IFSC Code : -

Name of the Account Holder : -

Personal Details

Date of Birth : 05-06-2003

Age completed as on 30.10.2023 : 20

Gender : MALE

Do you have twin brother / sister ? : NO

 Name of the twin : -

Gender of the twin : -

Marital Status : Unmarried

Father's Name : FAKRUDDIN ALI

Mother's Name : SHAYRA KHATUN

Spouse's Name : -

Address for Correspondence

Address 1 : VILLAGE SARADIHA POST

MAHUAWA
District : MAHARAJGANJ

State : UTTAR PRADESH

Pincode : 273303

Permanent address
Address 1 : VILLAGE SARADIHA POST
MAHUAWA
District : MAHARAJGANJ

State : UTTAR PRADESH

Pincode : 273303

Contact Details

Mobile No : +91 9598530286

Alternative Number : +91 9565884183

(Mobile No/Landline No)

Email ID : ajruddinali9889@gmail.com

Educational Qualification (as on 30.10.2023)

Exam Passed Degree/ Subject / Duration of Date of % of Marks Class / Grade

Stream Course (in Passing
years)

Matriculation/10th SCIENCE - 27-04-2019 75.83 First Class

HSC/12th or Equivalent Science - 31-07-2021 82.80 First Class

Diploma Pharmacy 2 12-09-2023 70.25 First Class

Are you qualified and registered as : YES

pharmacist under Pharmacy Act, 1948?

Other Details :

Languages Known Read Write Speak

HINDI YES YES YES

ENGLISH YES YES YES

Uploaded Document Details :

1. Left Thumb Impression

2. Hand Written Declaration

Declaration:

I hereby declare that all the statements made in this application are true, complete and correct to the best of my
knowledge and belief. I understand that in the event of any information being found false or incorrect at any stage or
not satisfying the eligibility criteria according to the requirements, my candidature/appointment is liable to be
cancelled/terminated.

Date: 09-10-2023

Left Thumb Impression

Hand Written Declaration