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Registered Online Application Form for 05-SCIENTIFIC ASSISTANT-B(CHEMISTRY) To The Assistant Personnel Officer(Recruitment) Atomic Minerals Directorate for Exploration & Research, Department of Atomic Energy,Government of India, 1-10-153-156,AMD Complex,Begumpet HYDERABAD-500016 With reference to your advertisement, I hereby submit my Application on : 2014-04-21 14:56:21
Advertisement No: Application No : 1/2014 01159616 Post Name: SNT AST-B(CHEM) Category : OBC Examination Center Preferred: Qualification: BENGALURU B.SC-MPC
Personal Details
Name Father's Name Gender If Person with Disability Date Of Birth Nationality State of Domicile : Mother Tongue Mobile Number Ex-Seviceman : : MAHESHWARI.E : P. ERUSAKGOUNDER : FEMALE : NO : Jun 4, 1989 : Indian TAMIL NADU : TAMIL : 9500700353 Email Id NO : [email protected] Age as on 01-01-2014 Religion : : 24 Yrs 06 Mths 28 Days Hindu ERORE : TAMIL,ENGLISH Marital Status : SINGLE
Nearest Raliway Station : Languages Known
Departmental Candidate
:
NO
Nearest Hospital :
GOVERNMENT HOSPITAL. BHAVANI
Are you a family member of those who died in 1984 RIOTS: Are you a dependent of defence service personal killed in action:
NO NO NO
Whether domiciled (resided) in the State of Jammu & Kashmir between 01/01/1980 and 31/12/1989:
Address forCorrespondence
:
5/10 A,ORICHERIPUDUR,ORICHERIPUDUR,BHAVANI,ERODE, TAMIL NADU,638316
Phone Number(With STD Code) :
95007-00353
Permanent Address
:
5/10 A,ORICHERIPUDUR,ORICHERIPUDUR,BHAVANI,ERODE, TAMIL NADU,638316
Phone Number(With STD Code) :
95007-00353
Continued Page 2 ....
Primary Qualifications and Additional Qualifications : % of Marks : 78.42% Month Of Year Of Passing Passing APR 2011 Class Secured Distinction
Sno Name of Degree
College SRI VASAVI COLLEGE
University BHARATHIAR UNIVERSITY
Marks Status
1
B.SC
78.42
Completed
Continued Page3...
The following documents are enclosed (to be submitted at the time of Interview):
1. 2. 3. 4. Online Application Form duly Signed and Affixed with recent colour passport size photograph. Photo copies / attested copies of Age Proof as per Matriculation certificate. Photo copies / attested copies of all Educational Qualifications with memorandum of marks. Photo copies / attested copies of latest Caste Certificate issued by Competent Authority (For SC/ ST/OBC Categories). 5. Photo copies / attested copies of latest Physical Disability Certificate issued by Competent Authority (For PWD Category). 6. Hall Ticket (Candidate's Copy) duly attested by Invigilator. 7. J & K Domicile Certificate issued by Competent Authority wherever applicable.
DECLARATION
1. I hereby declare that the above information is factually correct to the best of my knowledge and belief. 2. I am aware that my application is liable to be rejected if the information given is incomplete or found to be incorrect. 3. I understand that in the event of any information being found false or incorrect at any stage or not satisfying the eligibility conditions according to the requirements mentioned in the advertisement, my candidature /appointment is liable to be cancelled/ terminated. 4. I undertake to abide by all the conditions specified in the advertisement.
Place Date
: : Signature of the Applicant
Advertisement No: Application No : 1/2014 01159616 Post Name: SNT AST-B(CHEM) Category : OBC Examination Center Preferred: Qualification: BENGALURU B.SC-MPC
Personal Details
Name Father's Name Gender If Person with Disability Date Of Birth Nationality State of Domicile : Mother Tongue Mobile Number Ex-Seviceman : : MAHESHWARI.E : P. ERUSAKGOUNDER : FEMALE : NO : Jun 4, 1989 : Indian TAMIL NADU : TAMIL : 9500700353 Email Id NO : [email protected] Age as on 01-01-2014 Religion : : 24 Yrs 06 Mths 28 Days Hindu ERORE : TAMIL,ENGLISH Marital Status : SINGLE
Nearest Raliway Station : Languages Known
Departmental Candidate
:
NO
Nearest Hospital :
GOVERNMENT HOSPITAL. BHAVANI
Are you a family member of those who died in 1984 RIOTS: Are you a dependent of defence service personal killed in action:
NO NO NO
Whether domiciled (resided) in the State of Jammu & Kashmir between 01/01/1980 and 31/12/1989:
Address forCorrespondence
:
5/10 A,ORICHERIPUDUR,ORICHERIPUDUR,BHAVANI,ERODE, TAMIL NADU,638316
Phone Number(With STD Code) :
95007-00353
Permanent Address
:
5/10 A,ORICHERIPUDUR,ORICHERIPUDUR,BHAVANI,ERODE, TAMIL NADU,638316
Phone Number(With STD Code) :
95007-00353
Continued Page 2 ....
Primary Qualifications and Additional Qualifications : % of Marks : 78.42% Month Of Year Of Passing Passing APR 2011 Class Secured Distinction
Sno Name of Degree
College SRI VASAVI COLLEGE
University BHARATHIAR UNIVERSITY
Marks Status
1
B.SC
78.42
Completed
Continued Page3...
The following documents are enclosed (to be submitted at the time of Interview):
1. 2. 3. 4. Online Application Form duly Signed and Affixed with recent colour passport size photograph. Photo copies / attested copies of Age Proof as per Matriculation certificate. Photo copies / attested copies of all Educational Qualifications with memorandum of marks. Photo copies / attested copies of latest Caste Certificate issued by Competent Authority (For SC/ ST/OBC Categories). 5. Photo copies / attested copies of latest Physical Disability Certificate issued by Competent Authority (For PWD Category). 6. Hall Ticket (Candidate's Copy) duly attested by Invigilator. 7. J & K Domicile Certificate issued by Competent Authority wherever applicable.
DECLARATION
1. I hereby declare that the above information is factually correct to the best of my knowledge and belief. 2. I am aware that my application is liable to be rejected if the information given is incomplete or found to be incorrect. 3. I understand that in the event of any information being found false or incorrect at any stage or not satisfying the eligibility conditions according to the requirements mentioned in the advertisement, my candidature /appointment is liable to be cancelled/ terminated. 4. I undertake to abide by all the conditions specified in the advertisement.
Place Date
: : Signature of the Applicant
