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Pratibha BSCC Field Assistant Form

The document is an application form for the position of Field Assistant at the Bihar Staff Selection Commission, submitted by Pratibha Kumari. It includes personal details, educational qualifications, and a declaration of the accuracy of the information provided. Pratibha is a 25-year-old female from the Bania caste, with a permanent hearing disability and has submitted her application with the required fees.

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18 views2 pages

Pratibha BSCC Field Assistant Form

The document is an application form for the position of Field Assistant at the Bihar Staff Selection Commission, submitted by Pratibha Kumari. It includes personal details, educational qualifications, and a declaration of the accuracy of the information provided. Pratibha is a 25-year-old female from the Bania caste, with a permanent hearing disability and has submitted her application with the required fees.

Uploaded by

simple11266480
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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BIHAR STAFF SELECTION COMMISSION


P.O.-VETERINARY COLLEGE, PATNA - 800014
ADVERTISEMENT NO. 03/25
FIELD ASSISTANT
PERSONAL DETAILS
REGISTRATION NO.: 2530093306
FORM NO. : 3530093306
NAME OF APPLICANT : PRATIBHA KUMARI
FATHER'S NAME : SUNIL CHOUDHARY
MOTHER'S NAME : REKHA DEVI
GENDER : FEMALE
MOBILE NO. : 6207064629
EMAIL ID : [email protected]
DATE OF BIRTH : 06-01-1999 LIVE PHOTO

AGE AS ON 01-08-2024 : 25 YEARS, 6 MONTHS, 26 DAYS


NATIONALITY : INDIAN
CATEGORY : BC
DO YOU BELONG TO NON-CREAMY LAYER ? : YES
CASTE : BANIA / बनिया
(EBC/BC-NCLC CERTIFICATE NUMBER) / (SC/ST-CASTE CERTIFICATE
433
NUMBER) / (EWS-CERTIFICATE NUMBER) :
ISSUE DATE OF CERTIFICATE : 09-08-2017
CERTIFICATE ISSUING AUTHORITY : DM
PHOTO
DOMICILE OF BIHAR STATE : YES
ISSUE DATE OF DOMICILE CERTIFICATE: 30-09-2024
ISSUE NUMBER OF DOMICILE CERTIFICATE : BRCDM/2024/54104
DOMICILE CERTIFICATE ISSUING OTHER COMPETENT AUTHORITY : DM
SIGNATURE IN ENGLISH
ARE YOU PERSON WITH DISABILITY? : YES
NATURE OF DISABILITY? : PERMANENT
ARE YOU A PERSON WITH MINIMUM 40% DISABILITY(PWD)? : YES
WILL YOU NEED A SCRIBE?? : NO
SIGNATURE IN HINDI
TYPE OF DISABILITY: HEARING DISABLE
ISSUE DATE OF DISABILITY CERTIFICATE: 01-12-2016
DISABILITY CERTIFICATE NUMBER: 386
DO YOU HAVE AADHAR CARD? : YES (AADHAR CARD NUMBER: 526469417119)
ID PROOF : PAN CARD ID PROOF NO : FFPPK0387P
BIHAR GOVERNMENT EMPLOYEE WHO HAS RENDERED NOT LESS THAN 3 YEARS REGULAR AND
NO
CONTINUOUS SERVICE? :
NUMBER OF ATTEMPTS AFTER BIHAR GOVERNMENT EMPLOYEE? (AFTER DATE: 12-12-2022) : 00
IDENTIFICATION MARK OF THE CANDIDATE : CUT MARK ABOVE LEFT EYEBROW
ARE YOU AN EX-SERVICEMAN? : NO
WARD OF FREEDOM FIGHTER? : NO
HAVE YOU EVER BEEN DEBARRED FROM ANY COMPETITIVE EXAMINATION (UPSC/BOARD/STATE
NO
COMMISSION/ANY OTHER)? :
HAVE YOU WORKED UNDER BIHAR GOVERNMENT AFTER BEING RELEASED FROM NCC AFTER
NO
JANUARY 1, 1963?:
WORKED/WORKING AS CONTRACTUAL EMPLOYEE IN BIHAR GOVERNMENT: NO
ADDRESS DETAILS

CORRESPONDENCE ADDRESS PERMANENT ADDRESS

ADDRESS: AT+PO-SUKHPUR DIST-SUPAUL BIHAR ADDRESS: AT+PO-SUKHPUR DIST-SUPAUL BIHAR

VILLAGE/MOHALLA: SUKHPUR VILLAGE/MOHALLA: SUKHPUR

POST OFFICE: SUKHPUR POST OFFICE: SUKHPUR

POLICE STATION: SUPAUL POLICE STATION: SUPAUL

DISTRICT: SUPAUL DISTRICT: SUPAUL

STATE: BIHAR STATE: BIHAR

PIN CODE: 852130 PIN CODE: 852130

EDUCATIONAL QUALIFICATIONS
EDUCATION SUBJECT BOARD / TOTAL MARKS MARKS OBTAINED PERCENTAGE PASSINGDATE CERTIFICATE
UNIVERSITY / NUMBER
INSTITUTE
HINDI ENGLISH
10TH / SOCIAL SCIENCE
CBSE 500 427.5 85.40 20-05-2014 1138167
EQUIVALENT SCIENCE
MATHEMATICS
I.SC./10TH HINDI ENGLISH
+2 PHYSICS
BSEB 500 294 58.80 30-05-2017 3331987
(SCIENCE) CHEMISTRY
I.SC. BIOLOGY
PAYMENT DETAILS:
PAYMENT BANK : SBI
TRANSACTION ID : 1396119901955
TRANSACTION DATE : 2025-05-21 21:40:52
REGISTRATION FEE (RS.) : 135
DECLARATION DETAILS:

I HEREBY DECLARE THAT THE INFORMATIONS FILLED UP ABOVE BY ME ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I ALSO DECLARE
THAT I HAVE FILLED UP ONLY ONE APPLICATION FORM. I ALSO UNDERTAKE THAT IF ANY INFORMATION IS FOUND OTHERWISE, I SHALL BE LIABLE
FOR ANY LEGAL ACTION AND CANCELLATION OF MY CANDIDATURE.
DATE : 23-05-2025 19:01:21
DECLARATION ACCEPTED : YES

NOTE: PLEASE KEEP YOUR REGISTRATION NO.,PASSWORD,MOBILE NO AND EMAIL-ID CAREFULLY FOR FURTHER REFERENCE.

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