US17562

GOVERNMENT OF PUDUCHERRY DEPARTMENT OF PERSONNEL AND ADMINISTRATIVE REFORMS (PERSONNEL WING)

APPLICATION FOR THE POST OF Upper Division Clerk / Senior Clerk (PAY BAND - 1: Rs.5200-20200, GRADE PAY: Rs.2400/-) POST(S) APPLIED Name of the Post Code Order of Preference of Post 1

Upper Division Clerk

01

Applicant's Specimen Signature: 01. Application Number 02. Name of the Applicant 03. Father's / Husband's Name 04. Date of Birth 05. Age as on 31/05/2012 06. Gender 07. Address for Communication 08. Mobile Number 09. E-Mail 10. Educational Qualification Sl. No. 1 2 3 Qualification : : : : : : : US17562 BALAMURUGAN B BALASUBRAMANIAN 30/03/1982 30 years and 2 months MALE 58 CHETTY STREET PUDUCHERRY PUDUCHERRY - 605001 : +919345420661 : balaanandmca@gmail.com : Degree in Arts or Science Name of the Board/University Month & Year of Passing Apr, 1998 Apr, 2000 May, 2004

SSLC or equivalent TAMIL NADU STATE BOARD H.Sc or equi.,/Diploma TAMIL NADU STATE BOARD Degree B.SC, ED/PONDICHERRY UNIVERSITY : : : : : : : INDIAN HINDU GENERAL Yes PUDUCHERRY 0047786 30/06/2012

11. Nationality 12. Religion 13. Community 14. Have Regd. in Emp. Exchange a. Region b. Registration No. c. Next Renewal Date

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15. Category 16. Examination Centre Opted 17. Medium of Examination Opted

: Not Applicable : PUDUCHERRY : ENGLISH and TAMIL DECLARATION

1. I have read the provisions in the Notification of the examination carefully and hereby undertake to abide by them. 2. I declare that I am a Native / Resident of Union Territory of Puducherry by virtue of continuous residence for the last five years immediately preceding the date of Notification. 3. I have not submitted any other application for this examination. I am aware that if I contravene this, my application will be summarily rejected. 4. I further declare that I fulfill all the conditions of eligibility regarding age limits, educational qualifications etc., prescribed for admission to the examination. 5. I also declare that I have never been convicted by any court of law. I also declare that no charge sheet is pending against me in any court of law. I 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 being found suppressed / false or incorrect or ineligibility being detected before or after the examination, my candidature / appointment is liable to be cancelled.

DATE: 25/05/2012 PLACE: PUDUCHERRY Note: Unsigned application will be rejected.

SIGNATURE OF THE APPLICANT

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