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ON-LINE APPLICATION FOR COMMON WRITTEN EXAM FOR SPECIALIST OFFICERS

Please check Print Preview in A4 size Portrait format with 0.25" margin from all sides (Click to Print)
3000492220

tion # :

me :

Ankit Anil Dhapke

I.T.Officer (Scale-I) 01 OBC NO NA

e: :

with Disability :

Disability :

ge of Disability :

ntend to use the services of a scribe VI & OC both hands affected by cerebral palsy) ? :

you Children / family members of those who died in 1984 riots? : NO NO NO --NO INDIAN Maharashtra 30 Mumbai 130 CBS

you domiciled in Kashmir Division of the State of ng the period 1-1-1980 to 31-12-1989? :

an Employee of any participating Bank ? :

the Participating Bank :

e Number :

an Ex-Serviceman ? which the Centre of Examination Belongs : Examination :

ty / Citizenship :

T Code :

ode :

ion Fee / Intimation Charges details: Mode:

Payee Bank :

Punjab National Bank M424079 Mankapur Nagpur 622600 19-01-2012 450 29-09-1988 23 MALE Anil Dhapke Meena Dhapke 7 Lumbini Nagar Mankapur Koradi Road Nagpur Nagpur MAHARASHTRA 440030 7 Lumbini Nagar Mankapur Koradi Road Nagpur Nagpur MAHARASHTRA 440030

on No. :

ame :

/ Branch Code No :

Date :

Details :

irth :

pleted as on 01.12.2011 :

s Name/Father's Name :

Name :

or Correspondence :

nt Address :

etails :

ankitdhapke@gmail.com 0712-6458806 9730856558

Exam Passed Degree Subject /Stream Date of Passing % of Marks Class / Grade

o:

o:

ation Details (as on 01.12.2011): Graduation: Diploma :

Designation and Rank if any

BCA Others-MSCIT

Computer Science

18-01-2010 01-09-2004
Nature of Duties Performed

49.33 85.00

Second Class First Class

te for Post Qualification Work Experience should be 01.12.2011

From(mm/yyyy) To(mm/yyyy) Remark(Reason for Leaving)

the Employer & of Employment

Year Service (

A IT Servs Pv t Ltd

Team Leader

01/2011

12/2011

Technical Support and team mngmnt

Process Shutdown

0/

MSI Pune

Process Executive

05/2010

12/2010

Auditing

Personal Reason

0/

perience (in months) : Languages Known Read Write Speak

English Marathi Hindi

YES YES YES

YES YES YES

YES YES YES

TION:

hereby declare that all 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 be orrect at any stage or my not satisfying any of the eligibility criteria stipulated, my candidature is liable to be cancelled.

01-2012

Signature of A

retain your Registration No. and Password emailed to you carefully for further reference

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