Gram Panchayat Secretary Application Form
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mckbf chklnGram Panchayat Secretary Application Form
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mckbf chkln12/22/2016
Application No.:
PMD0046051101
Application Form For Appointment to the post of Gram Panchayat
Secretary under Purba Medinipur District
Advertisement Reference No.: 09/PRD/XXIII04/2016, DATE : 07/12/2016
1. Name: NANDAN NAYEK 2. Post applied for: Gram Panchayat Secretary
3. Sex: Male 4. Category: UR
5. Physically Challenged : No 6. Date of Birth: 15/03/1995
7. Father's Name: HARIPADA NAYEK 8. Exempted Category: No
9. Mother's Name: REKHA RANI NAYEK 10. Email: nandannayek1@[Link]
11. Mobile: 7407203446
12. Communication Address:
Street/Area: VILLCHAKCHANDI ,P.OPINDRUI ,P.S Block/Municipality: PINGLA
PINGLA , DISTPASCHIM MEDINIPUR
Post Office: PINDRUI District: PASCHIM MEDINIPUR
PIN/ZIP code: 721131 State: WEST BENGAL
Country: INDIA
13. Permanent Address:
Street/Area: VILLCHAKCHANDI ,P.OPINDRUI ,P.S Block/Municipality: PINGLA
PINGLA , DISTPASCHIM MEDINIPUR
Post Office: PINDRUI District: PASCHIM MEDINIPUR
PIN/ZIP code: 721131 State: WEST BENGAL
Country: INDIA
14. Essential/Desirable Qualification:
Examination Passed Board/ University Year of Passing Class/Division Percentage/CGPA
Madhyamik / 10 th or equivalent West Bengal Board of Secondary
2011 2ND 38
Education, Calcutta
Any other If Any
DECLARATION:
I declare that the above information entered by me are true, complete and correct. I shall produce all testimonials in original as and when ask
for, to the authority. I agree to abide by all the rules framed by District Level Selection Committee, Purba Medinipur throughout the process
of recruitment.
Date: 22/12/2016 08:11:03 PM
Place: Purba Medinipur
(Signature of the applicant)
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