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Acknowledgement

This document is an application form for the recruitment of Firemen in Chhattisgarh Fire and Emergency Services, with the applicant being Himanshu Gahirware. It includes personal details, educational qualifications, and a declaration of the truthfulness of the information provided. The application was submitted on July 28, 2025, with a payment of 208.0 and includes uploaded certificates.

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himanshugahirware06
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23 views2 pages

Acknowledgement

This document is an application form for the recruitment of Firemen in Chhattisgarh Fire and Emergency Services, with the applicant being Himanshu Gahirware. It includes personal details, educational qualifications, and a declaration of the truthfulness of the information provided. The application was submitted on July 28, 2025, with a payment of 208.0 and includes uploaded certificates.

Uploaded by

himanshugahirware06
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Chhattisgarh Fire and Emergency Services Recruitment

APPLICATION FORM

ADVERTISEMENT NUMBER & DATE NOTIFICATION NUMBER- 713 & Date 12/06/2025

POST NAME Firemen

PERSONAL DETAILS

REGISTRATION NUMBER: 1028270

APPLICANT'S FULL NAME : HIMANSHU GAHIRWARE

FATHER’S OR HUSBAND’S NAME : TAMESHWAR GAHIRWARE

GENDER : MALE

DATE OF BIRTH : 04-05-2006

CATEGORY: SC

MOBILE NUMBER : 8827702918

E-MAIL ID : [email protected]

IDENTITY TYPE : Aadhar

IDENTITY NO : 203887262729

IDENTIFICATION MARKS : Cut on left hand

ADDRESS DETAILS

CORRESPONDENCE ADDRESS PERMANENT ADDRESS

ADDRESS LINE1 40f ADDRESS LINE1 13

ADDRESS LINE2 Risali Sector ADDRESS LINE2 Ward 6 Hathkhoj Para

VILLAGE/TOWN Bhilai VILLAGE/TOWN Utai

DISTRICT Durg DISTRICT Durg

STATE Chhattisgarh STATE Chhattisgarh

PINCODE 490006 PINCODE 491107

OTHER INFORMATION

ARE YOU AN EX-SERVICEMAN? No

ARE YOU A HOME GUARD? No

ARE YOU INTER CASTE MARRIED? No

ARE YOU A GOVERNMENT EMPLOYEE? No

HAVE YOU RECEIVED ANY AWARDS? No


EDUCATIONAL QUALIFICATIONS

EDUCATIONAL QUALIFICATION BOARD NAME OR UNIVERSITY COURSE TYPE YEAR OF PASSING


NAME

10Th Chhattisgarh Board of secondary 2021


education, Raipur

12Th Chhattisgarh Board of secondary 2023


education, Raipur

PREFERENTIAL QUALIFICATIONS

HAVE YOU PARTICIPATED IN THE NATIONAL CADET CORPS (NCC) AND OBTAINED A “C” CERTIFICATE No

HAVE YOU WON AN AWARD IN ANY NATIONAL LEVEL SPORTS? No

DO YOU POSSESS A VALID HEAVY MOTOR VEHICLE (HMV) DRIVING LICENSE? No

PAYMENT DETAILS

TRANSACTION NUMBER AMOUNT TRANSACTION DATE

pay_QyRV2kHuWNxJUH 208.0 28-07-2025 15:15:31

CERTIFICATES UPLOADED

1 Aadhar Certificate

2 Domicile Certificate

3 Category Certificate

4 10th Certificate

5 12th Certificate

DECLARATION BY THE CANDIDATE

I HEREBY DECLARE THAT THE INFORMATION GIVEN ABOVE 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 NOT TRUE,WILL HAVE TO FACE THE
CONSEQUENCES AS PER THE LAW. ALSO, ALL THE BENEFITS AVAILED BY ME SHALL BE SUMMARILY WITHDRAWN.

PRINT DATE & TIME :28-07-2025 15:15:54

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