10/5/2015
Server 1 Welcome to Odisha Staff Selection Commission
ODISHA STAFF SELECTION COMMISSION Barrack No.1, Unit No.V, Bhubaneswar751054 | Tel: 0674 2393770 | Fax: 06742391153
150839018131
Application Form Applicant Copy (To be retained by the applicant) 1. Post Code and Name 2. Advertisement No. and Date 3.
Choice of district for appearing in the examination
39
Junior Assistant And Junior Clerk
15Aug2015
4282 Malkanagiri
4. Full Name Of the Applicant
Mr. Tapan Kumar Sarkar
5. Father's Name
Mr. Bishnupada Sarkar
6. Mother's Name
Mrs. Saraswati Sarkar
7. Name of the husband in case of Married female applicant
NA
8. Personal Details a. Nationality Indian
Hindu
NCC Reservation Certificate g. Category received, if any
f. SC
NA
Whether Ex Serviceman
j.
Whether holder of n. Sports Person Certificate No
d. Date of Birth.
Male
25Oct1992
e. Age as on 01Jan2015 Year 22
h. Physically Challenged (Yes / No)
No
No
3
NA
o.
NA
Yes
ID card no. issued by Director of Sports (in case of p. State Level Medal Sports Person) No
r. International Level Medal
s.
InService (Govt. Contractual) No
No
From
Month
i. Type of Physical disability
NA
National Level Medal
q.
c. Sex
Period of Service Whether passed Date/ Likely Date of Discharge (in k. rendered (in l. m. minimum Seventh case of ExServiceman) case of Ex class Exam. in Odia Serviceman) NA
No
t.
b. Religion
u. To
v.
Total InService Experience 0.0
9. Address for Correspondence (All Communication to the candidate from OSSC is to be made in this address) a.
Address with Pincode:
Balimela Road . P.O/P.S Malkangiri ,Pincode: 764045
b. District :
Malkanagiri
d. Telephone :
c. State : e. Mobile :
f. eMail :
8763734374
Odisha
[email protected]
10. Permanent Address a.
Address with Pincode:
b. District :
Balimela Road . P.O/P.S Malkangiri ,Pincode: 764045 Malkanagiri
c. State :
Odisha
11. Educational Qualification 10th Standard Roll Number As Mentioned in the Certificate
03PF121
10th Standard Exam Type
Annual
http://online.odishassc.in/Form/R_PrintOnlineForm_N.aspx?ApplicantId=150839018131
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10/5/2015
Server 1 Welcome to Odisha Staff Selection Commission Examination
Stream
Board/University
YOP
Division
Total Marks/CGPA
Secured Marks/CGPA
%Age
HSC
***
BSE, ODISHA
2007
Second
750
416
55.46
10+2 /Equivalent
SCIENCE
CHSE, ODISHA
2009
First
600
435
72.50
12. Work experience details.( If in Govt. Service ) Name of the Post held: Whether
From :
Whether appointed following due procedure
To :
13. Treasury Challan Details (Original Challan has to be submitted along with the hard copy of the application) (Candidates belonging to SC/ST/PWD Categories are exempted from paying the exam fees.) Treasury Challan / Reference Number:
NA
Date :
NA
Name of Treasury
NA
Amount
0
Proficiency in Computer Knowledge
Yes
14. Application Details Applicant Id :
150839018131
Password : DD6D7D8A71
NB : Your Online application has been submitted successfully.
http://online.odishassc.in/Form/R_PrintOnlineForm_N.aspx?ApplicantId=150839018131
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10/5/2015
Server 1 Welcome to Odisha Staff Selection Commission
ODISHA STAFF SELECTION COMMISSION Barrack No.1, Unit No.V, Bhubaneswar751054 | Tel: 06742393770 | Fax: 06742391153
150839018131
Application Form OSSC Copy
Junior Assistant And Junior Clerk
2. Advertisement No. and Date 3.
39
1. Post Code and Name
15Aug2015
4282
Choice of district for appearing in the examination
Malkanagiri
4. Full Name Of the Applicant
Mr. Tapan Kumar Sarkar
5. Father's Name
Mr. Bishnupada Sarkar
6. Mother's Name
Mrs. Saraswati Sarkar
7. Name of the husband in case of Married female applicant
NA
8. Personal Details a. Nationality
b. Religion
Indian
f.
Reservation Category
Hindu
g.
SC
j.
d.
Male
NCC Certificate received, if any
NA
Whether Ex Serviceman
c. Sex
NA
Year
25Oct1992
Physically h. Challenged (Yes / No)
i.
No
q.
m.
Whether passed minimum Seventh class Exam. in Odia
NA
Yes
NA
National Level Medal
No
t. From
State Level Medal
s.
InService (Govt. Contractual)
v.
Total InService Experience
No
u. To
p. No
r. International Level Medal
No
3
Type of Physical disability
Whether holder ID card no. issued by Director of Sports (in case of Sports n. of Sports Person o. Person) Certificate No
Month
22
NA
Period of Date/ Likely Service Date of k. rendered (in l. Discharge (in case of Ex case of Ex Serviceman) Serviceman)
No
Date of Birth. e. Age as on 01Jan2015
0.0
9. Address for Correspondence (All Communication to the candidate from OSSC is to be made in this address) a.
Address with Pincode:
Balimela Road . P.O/P.S Malkangiri ,Pincode: 764045
b. District :
Malkanagiri
d. Telephone :
c. State : e. Mobile :
f. eMail :
8763734374
Odisha
[email protected]
10. Permanent Address a.
Address with Pincode:
b. District :
Balimela Road . P.O/P.S Malkangiri ,Pincode: 764045
c. State :
Malkanagiri
Odisha
11. Educational Qualification 10th Standard Roll Number As Mentioned in the Certificate
03PF121
10th Standard Exam Type
Annual
Examination
Stream
Board/University
YOP
Division
http://online.odishassc.in/Form/R_PrintOnlineForm_N.aspx?ApplicantId=150839018131
Total Marks/CGPA
Secured Marks/CGPA
%Age
3/5
10/5/2015
Server 1 Welcome to Odisha Staff Selection Commission HSC
***
BSE, ODISHA
2007 Second
750
416
55.46
10+2 /Equivalent
SCIENCE
CHSE, ODISHA
2009 First
600
435
72.50
12. Work experience details.( If in Govt. Service ) Name of the Post held:
From :
Whether
Whether appointed following due procedure
Proficiency in Computer Knowledge
To :
Yes
13. Treasury Challan Details (Original Challan has to be submitted along with the hard copy of the application) (Candidates belonging to SC/ST/PWD Categories are exempted from paying the exam fees.) Treasury Challan / Reference Number:
NA
Date :
NA
Name of Treasury
NA
Amount
0
DECLARATION I __________________________ Son/ Daughter of Shri _________________________Age___________ Year__________ resident of ________________ District ________________ hereby declare that the information given above and in the enclosed documents is true to the best of my knowledge and belief and nothing has been concealed therein. I am well aware of the fact that if the information given by me is proved false/ not true, I will have to face the punishment as per the law. Also, all the benefits availed by me shall be summarily withdrawn. Signature should not exceed the box provided
Date :
Place :
Full Signature of the Applicant (Ink Signed)
http://online.odishassc.in/Form/R_PrintOnlineForm_N.aspx?ApplicantId=150839018131
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10/5/2015
Server 1 Welcome to Odisha Staff Selection Commission
Sender
By
Post
From
Application for the Post of : Junior Assistant And Junior Clerk
Name
Mr. Tapan Kumar Sarkar
Father's Name
Mr. Bishnupada Sarkar
To
Plot No, / Lane
Balimela Road . P.O/P.S
The Secretary,
Name / Village
Malkangiri
Odisha Staff Selection Commission,
District Name
Malkanagiri
PIN Code
764045
Barrack No.1, Unit No.V, Bhubaneswar751054 . Tel: 0674 2392233 Fax: 06742391153
http://online.odishassc.in/Form/R_PrintOnlineForm_N.aspx?ApplicantId=150839018131
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