ONLINE APPLICATION REGISTRATION FOR HEALTH INSPECTOR
GRADE - II 2025
USER ID MRBHI25007988
POST APPLYING FOR HEALTH INSPECTOR GRADE - II
PERSONAL DETAILS
NAME SATHISHKUMAR P
NATIONALITY INDIAN
ARE YOU APPLYING UNDER THE EX-SERVICEMEN NO
CATEGORY?
DO YOU HAVE COMMUNITY CERTIFICATE ISSUED BY YES
TAMILNADU GOVT.?
COMMUNITY BC
SUB CASTE KONGUVELLALAR INCL. VELLALA GOUNDER/NATTU GOUNDER/
NARAMBUKATTIL GOUNDER/TIRUMUDI VELLALAR/THONDU VELLALAR/PALA
GOUNDER/POOSARI GOUNDER/ANUPPU VELLALA GOUNDER/PADAITHALAI
GOUNDER/CHENDALAI GOUNDER/PAVALANKATTI VELLALA GOUNDER/PALA
VELLALA GOUNDER/ SANGU VELLALA GOUNDER & RATHNAGIRI GOUNDER
ISSUING AUTHORITY OF COMMUNITY CERTIFICATE ZONAL DEPUTY TAHSILDAR
COMMUNITY CERTIFICATE NO TN-520190428524
COMMUNITY CERTIFICATE PLACE OF ISSUE KARIMANGALAM
COMMUNITY CERTIFICATE ISSUING DATE 03-MAY-2019
ARE YOU DIFFERENTLY ABLED? NO
HAVE YOU ALREADY APPLIED FOR THIS HEALTH YES
INSPECTOR GRADE - II POST AS PER NOTIFICATION
NO. 06/MRB/2023, DATED: 11.07.2023?
APPLICATION NUMBER FOR THE REGISTRATION IN 230604564
PREVIOUS NOTIFICATION
ENTER EMAIL ID OR MOBILE NO (USED IN PREVIOUS 9791158443
NOTIFICATION):
DATE OF BIRTH (AS PER SSLC MARK SHEET) 22-APR-1990
AGE AS ON 01-07-2025 35 YEARS 2 MONTHS 9 DAYS
EMAIL ID KPSATHISH09@[Link]
MOBILE NO 9791158443
WOULD YOU LIKE TO GIVE FATHER AND MOTHER FATHER AND MOTHER
NAME OR GUARDIAN NAME
FATHER'S NAME PALANIVEL K
MOTHER'S NAME JAYANTHI K
ARE YOU MARRIED YES
NAME OF SPOUSE MYVIZHI C
NATIVITY DHARMAPURI - TAMIL NADU
GENDER MALE
RELIGION HINDU
ARE YOU ALREADY IN GOVERNMENT SERVICE? NO
PHOTO ID PROOF DETAILS
05-11-2025 04:51:59 1
PHOTO ID PROOF VOTER ID
PHOTO ID PROOF NO. AQA0118349
PERMANENT ADDRESS
ADDRESS 4/445 SENGUTTAI K. EACHAMPADI POST
STATE TAMIL NADU
DISTRICT DHARMAPURI
CITY / VILLAGE KARIMANGALAM TK
PINCODE 635202
CORRESPONDENCE ADDRESS
ADDRESS 4/445 SENGUTTAI K. EACHAMPADI POST
STATE TAMIL NADU
DISTRICT DHARMAPURI
CITY / VILLAGE KARIMANGALAM TK
PINCODE 635202
MOTHER TONGUE
MOTHER TONGUE TAMIL
EDUCATIONAL QUALIFICATION
EXAMINATION NAME OF THE BOARD OTHER HAVE YOU SPECIALIZAT MONTH/ MEDIUM HAVE YOU CERTIFICAT
BOARD PASSED TAMIL ION YEAR OF OF STUDIED E ISSUED
LANGUAGE AS A PASSING INSTRUCTI TAMIL AS DATE
SUBJECT IN ON ONE OF
S.S.L.C. LEVEL? THE
LANGUAGE
(PART-1)
10TH / SSLC TAMIL NADU STATE - YES - MARCH TAMIL - 04-
BOARD 2005 JUN-2005
12TH / HSC TAMIL NADU STATE - - BIOLOGY MARCH TAMIL YES 14-
BOARD 2007 MAY-2007
EXAMINAT CERTIFICA OTHER PERIOD OF PERIOD OF DURATION NAME OF MONTH & MEDIUM HAVE YOU CERTIFICA
ION TE EQUIVALEN STUDY STUDY TO OF STUDY INSTITUTI YEAR OF OF STUDIED TE ISSUED
COURSE T FROM (NO. OF ON PASSING INSTRUCT TAMIL AS DATE
NAME QUALIFICA YEARS) ION ONE OF
TION THE
LANGUAGE(
PART-1)
CERTIFICA TWO - 2017 2019 2 OHM NOVEMBER TAMIL NO 22-
TE YEARS SAKTHI 2019 NOV-2019
COURSE MULTIPUR HEALTH
POSE SCIENCE
HEALTH AND
WORKER RESEARCH
(MALE) INSTITUTIO
COURSE N,
KOMARAP
ALAYAM
ARE YOU ELIGIBLE TO AVAIL PSTM PREFERENCE? NO
OTHER QUALIFICATION
DO YOU HAVE ANY OTHER QUALIFICATION? YES
NAME OF THE QUALIFICATION INSTITUTION NAME MONTH & YEAR OF CERTIFICATE
PASSING ISSUED DATE
BE CSE JAYA ENGINEERING COLLEGE APRIL 2011 30-DEC-2014
ME CSE RAJIV GANDHI COLLEGE OF ENGINEERING JUNE 2013 04-NOV-2013
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COVID DUTY CERTIFICATE
HAVE YOU WORKED IN COVID PERIOD? YES
INSTITUTION NAME OF DISTRICT ADDRESS OF PERIOD OF PERIOD OF DURATION CERTIFICATE CERTIFICATE
TYPE THE THE WORK-FROM WORK-TO OF COVID SIGNED BY COUNTER
MEDICAL INSTITUTION SERVICE SIGNED BY
INSTITUTION
PRIMARY COMMUNITY TIRUPATTUR COMMUNITY 27-APR-2020 31-DEC-2021 1 YEARS 8 BLOCK DEPUTY
HEALTH HEALTH HEALTH MONTHS 5 MEDICAL DIRECTOR OF
CENTRES CENTRE CENTRE, DAYS OFFICER HEALTH
KUNICHI, SERVICES
THIRUPATH
UR
TOTAL DURATION OF COVID SERVICE 1 YEARS 8 MONTHS 5 DAYS
UPLOAD DOCUMENTS
DOCUMENT NAME FILE NAME
COMMUNITY CERTIFICATE [Link]
SSLC CERTIFICATE [Link]
HSC CERTIFICATE [Link]
COURSE CERTIFICATE HI_COURSE.PDF
OTHER QUALIFICATION CERTIFICATE 1 UG_DGREE.PDF
OTHER QUALIFICATION CERTIFICATE 2 PG_DEGREE.PDF
COVID DUTY CERTIFICATE HI_COVID_EXPERIENCE.PDF
DECLARATION
I HEREBY DECLARE THAT ALL THE PARTICULARS FURNISHED IN THIS APPLICATION ARE TRUE, CORRECT AND COMPLETE TO THE BEST OF
MY KNOWLEDGE AND BELIEVE. IN THE EVENT OF ANY INFORMATION BEING FOUND FALSE OR INCORRECT OR INELIGIBILITY BEING DETECTED
BEFORE OR AFTER THE SELECTION, ACTION CAN BE TAKEN AGAINST ME BY THE MRB.
I HEREBY DECLARE THAT I WILL NOT BE A PARTY TO ANY KIND OF CANVASSING ON MY BEHALF.
I FURTHER DECLARE THAT I FULFIL ALL THE ELIGIBILITY CONDITIONS PRESCRIBED FOR ADMISSION TO THIS POST.
I HAVE INFORMED MY EMPLOYER IN WRITING THAT I AM APPLYING FOR THIS POST AND FURNISH THE NOC FOR THIS PURPOSE (IF
APPLICABLE).
I HAVE GONE THROUGH THE INSTRUCTIONS ETC. TO CANDIDATES AND THE BOARDS NOTIFICATION FOR THIS RECRUITMENT, BEFORE
FILLING UP THE APPLICATION FORM AND I AM ELIGIBLE TO APPLY FOR THIS POST.
I DECLARE THAT I POSSESS THE MEDICAL STANDARDS PRESCRIBED FOR THE POST(S) WHICH I AM NOW APPLYING.
I CERTIFY THAT I HAVE NOT BEEN DEBARRED / DISQUALIFIED BY THE BOARD OR ANY OTHER RECRUITING AGENCY.
I AM NOT A DISMISSED GOVERNMENT EMPLOYEE.
THERE IS NO CRIMINAL CASE FILED AGAINST ME IN THE POLICE STATION / COURT.
THERE IS NO VIGILANCE CASE FILED AGAINST ME.
I HEREBY DECLARE THAT MY CHARACTER / ANTECEDENTS ARE SUITABLE FOR APPOINTMENT TO THIS POST.
I DECLARE THAT I DO NOT HAVE MORE THAN ONE LIVING SPOUSE / I AM UNMARRIED.
I ACCEPT THAT IF ANY SUPPRESSION / INCORRECT / FALSE / MISLEADING INFORMATION SUBMITTED IN THE ONLINE APPLICATION WILL
RESULT IN THE REJECTION OF MY CANDIDATURE WITHOUT FURTHER NOTICE.
☑ I ACCEPT THE ABOVE DECLARATION.
☑ I HAVE ENSURED THAT EVERYTHING HAS BEEN FILLED CORRECTLY, BEFORE PROCEEDING TO PAYMENT. I KNOW THAT THE DATA
ENTERED CAN'T BE CHANGED ONCE PROCEEDED TO PAYMENT. HENCE, BEFORE PROCEEDING FURTHER, THE DETAILS ALREADY
ENTERED ARE VERIFIED BY ME TO ENSURE THAT THEY ARE CORRECT. I HAVE FOUND THAT THE DETAILS ARE CORRECT, AND NOW
PROCEED TO MAKE ONLINE PAYMENT TOWARDS APPLICATION FEES.
SUBMITTED DATE : 05-NOV-2025 (SIGNATURE OF THE CANDIDATE)
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