LALA LAJPAT RAI

UNIVERSITY OF
VETERINARY AND Version No.: 1.3
Form No.:

ANIMAL SCIENCES, 123028042

HISAR, HARYANA
-125004
::Personal Information::

Name of the Candidate (in

ANAND
Capital Letters):

Father's Name(in Capital

Letters): JAIBIR

Mother’s Name(in Capital पती / पत्नी का नाम / Spouse

Letters): DARO DEVI
Name:

Gender(M/F): Male Marital Status: UnMarried Religion:Hindu Nationality: Indian

Aadhar No: 999154400102 Driving License no: PAN: DVDPA9750C

::Contact Details::

Permanent Address: Present Postal Address:

HNO. -178, RAJARAM DHAMU FARMHOUSE, NEAR DAROLI HNO. -178, RAJARAM DHAMU FARMHOUSE, NEAR DAROLI
MINOR MINOR
City: VPO MOHABATPUR, Tehsil: ADAMPUR, Dist: Hisar, State: City: VPO MOHABATPUR, Tehsil: ADAMPUR, Dist: Hisar, State:
Haryana Pin Code:125052 Haryana Pin Code:125052

Contact Number: 7015525174, Email ID: backup007rd@GMAIL.COM

Whether differently abled Yes/No:No

Whether belong to SC/BC/ESM/PWD/EBP:General(if yes, attach a certificate from the competent authority.)

Are you a domicile of Haryana state: Yes

Date of Birth and place: 18/09/2000 Age as on last date of receipt of application: 23 (years) 3 (months)

::Educational Qualifications::

मैिट्रक िहं दी/संस्कृत एक िवषय सिहत? Hindi/Sanskrit as one of the subjects in Matriculation or Higher Education: Yes

Title of
Exam University/ Year of Marks Obtained Maximum %age of
Subject the
Passed Board Passing (Accurate) Marks Marks
Thesis

Class 10th-
Haryana Board of
Class 10th 22 May 2016 408.00 500 81.60
Education
(General)

12th/10+2-
12th/10+2 Haryana Board of 1 August
348.00 500 69.60

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 (Arts) Education 2022

11
Diploma-
AICTE September 4618.00 7100 65.04
Other
2020

:: Applied Posts

Post
Payment
S.N. Adv. No. Post Name Application
Status
Id

1. Advt. No. 1/2023 Group D- Attendant Paid 1046467

::Employment Details (in Chronological Order)::

::Language Informations::

What is your mother tongue? Hindi

Name the languages both Indian & Foreign which you can read, write and/or speak. Give particulars and examinations(s), if any, passed in
each:

Sr.No. Language Name Mother Tounge Read Write Speak Examination(s) Passed

1 Hindi YES YES YES YES YES

2 English NO YES YES YES YES

Have you ever been disqualified from appearing in any University Examination/undertaking University work (say yes or no): NO

Are you a dismissed employee? (Say yes or no): NO

Whether any criminal case has been registered against applicant( Yes/No): NO

Whether applicant has been charge-sheeted for any criminal offence? If yes, the details thereof: NO

Whether applicant has been convicted by any competent court for any criminal offence? If yes, the details thereof: NO

::REFERENCES::

REFERENCES: (These persons should be professionally competent, who are well acquainted with some aspect of the applicant’s training
accomplishment, capabilities and character but must not be related to the candidate. Two references should be listed and at least one of them
should be a citizen of India. For applicants having done Post Graduate or Post doctoral research, the Research Supervisor must be listed.)

Sr.No. Name MobileNo EmailId Address

1 SAHDEV MACHRA 8607530891 VPO Ban Mandori, Tehsil Fatehabad Pin 125053

2 Chander Mohan 8607266908 VPO Banawali, Tehsil Fatehabad Pin 125053

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 ::List of Enclosures ::

Uploaded
Sr.No. Document Name
Status

1. ANNEXURE - IV Yes

2. Document for Language Exam : 12th Yes

3. Document for Qualification 12th/10+2 - (12th/10+2) - (Arts) Yes

4. Document for Qualification Class 10th - (Class 10th) - (General) Yes

5. Document for Qualification Diploma - (DIPLOMA IN MECHANICAL ENGINEERING TOOL AND DIE) Yes

6. Haryana Domicile Certificate Yes

7. PPP (Parivar Pahachan Patra) Card Yes

Whether the applicant or any person from amongst the applicant’s family is/was or has been a regular
employee in any Department/Board/Corporation/Company/Statutory Body/Commission/Authority of
Haryana Government or any other State Government or Government of India? - Yes

Whether the gross annual income of the family from all sources i.e., salary, agriculture, business, profession
etc. for the financial year prior to the year of application is less than one lakh eighty thousand rupees only?
- No

यिद आवेदक िवधवा है ? / Is applicant a Widow? - No

Whether the applicant is the first or the second child and his father had died before attaining the age of 42
years OR If the applicant is the first or the second child and his father had died before the applicant had
attained the age of 15 years, then he/she will be entitled to 5 per cent subsidy subject to entries in the
family identity card (Pariwar Pehchan Patra) or certificate issued by the competent authority in the
specified Performa. - No

Whether the applicant belongs to such a denotified tribe (Vimukt Jatis and Tapriwas Jatis) or Nomadic tribe
of Haryana which is neither a Scheduled Caste nor a Backward Class. - No

I certify that the foregoing information given by me is correct, complete to the best of my knowledge and belief and no material information has been
concealed. I am not aware of any circumstances which may impair my fitness for employment.

Date: Signature of the candidate:

Printed on: 05/01/2024, 4:56 PM

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