0% found this document useful (0 votes)
34 views4 pages

SSC Stenographer Application Print

This document is an application form for the Stenographer Grade C and D examination submitted by Paritosh Panigrahi. It contains his personal details like name, father's name, date of birth, address, education qualifications, preference of examination centers, declaration of truthfulness of the information provided, and details of application fee payment. The form was received on August 9, 2023 containing uncertified contents.

Uploaded by

gumnaamgulati05
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
0% found this document useful (0 votes)
34 views4 pages

SSC Stenographer Application Print

This document is an application form for the Stenographer Grade C and D examination submitted by Paritosh Panigrahi. It contains his personal details like name, father's name, date of birth, address, education qualifications, preference of examination centers, declaration of truthfulness of the information provided, and details of application fee payment. The form was received on August 9, 2023 containing uncertified contents.

Uploaded by

gumnaamgulati05
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

STAFF SELECTION COMMISSION

BLOCK NO. 12, CGO-COMPLEX, LODHI ROAD, NEW DELHI


110003
STENOGRAPHER GRADE µC¶ µD¶EXAMINATION,
2023
REGISTRATION NO: 50003222328
APPLICATION RECEIVED (CONTENTS NOT VERIFIED)
1. NAME AS PER MATRICULATION 2. NEW/ CHANGED
3. FATHER'S NAME 4. MOTHER'S NAME
CERTIFICATE NAME
RUDRA NARAYAN
PARITOSH PANIGRAHI - MONITA PANIGRAHI
PANIGRAHI
6. AGE AS ON
5. DATE OF BIRTH (DD/MM/YYYY) 01/08/2023 7. GENDER 8. CATEGORY

21/09/1998 24.1 MALE UNRESERVED


9.1 IF YES, TYPE OF DISABILITY (OH, HH,VH,
9. WHETHER PERSON WITH DISABILITY (PwBD) ?
OTHERS)
NO -
10. NATIONALITY 11. MARK OF VISIBLE IDENTIFICATION
CITIZEN OF INDIA LEFT LEG GOT A CUT
13. MATRICULATION 14. MATRICULATION (10th
12. MATRICULATION (10th CLASS) EXAMINATION BOARD
(10th CLASS) ROLL NO CLASS) YEAR OF PASSING
CENTRAL BOARD OF SECONDARY EDUCATION (CBSE) 6135818 2014
15. DO YOU POSSESS KNOWLEDGE OF STENOGRAPHY ?
YES
16. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER
(FIRST PREFERENCE ) (SECOND PREFERENCE ) (THIRD PREFERENCE )
BILASPUR ( 6202 ) RAIPUR ( 6204 ) DURG ( 6205 )
17.1. WHETHER YOU ARE AN EX- 17.2. DATE OF JOINING THE 17.3. DATE OF DISCHARGE/ LIKELY DATE
SERVICEMAN (ESM) OR SERVING IN ARMED FORCES (DD/MM/YYYY) OF DISCHARGE FROM ARMED FORCES
THE ARMED FORCES? (DD/MM/YYYY)
NO - -
17.5 HAVE YOU ALREADY JOINED
17.4. LENGTH OF SERVICE IN ARMED A CIVIL POST BY AVAILING 17.4. DATE OF JOINING TO CIVIL POST
FORCES BENEFIT OF RESERVATION FOR (DD/MM/YYYY)
EX-SERVICEMAN (ESM) ?
- - -
18.1. ARE YOU A PERSON WITH BENCHMARK DISABILITIES (40% OR MORE) IN THE CATEGORY OF OH-
CEREBRAL PALSY (OH-CP)?
-
18.2. ARE YOU A PERSON WITH BENCHMARK DISABILITIES (40% OR MORE) IN THE CATEGORY OF
BLINDNESS (VH)?:
-
18.3. ARE YOU A PERSON WITH BENCHMARK DISABILITIES (40% OR MORE) IN THE CATEGORY OF OH-
BOTH ARMS AFFECTED (OH-BA)?:
-
18.4. DO YOU HAVE A PHYSICAL LIMITATION TO WRITE AND SCRIBE IS REQUIRED TO WRITE ON YOUR BEHALF
(CERTIFICATE TO THIS EFFECT FROM THE CHIEF MEDICAL OFFICER/ CIVIL SURGEON & MEDICAL SUPERINTENDENT
OF A GOVERNMENT HEALTH CARE INSTITUTION AS PER NOTICE OF THE EXAMINATION WOULD BE REQUIRED AT
THE TIME OF EXAMINATION) ?
NO
18.5. WHETHER SCRIBE IS REQUIRED ? 18.6. WILL YOU MAKE YOUR OWN 18.7. IF SCRIBE IS TO BE ARRANGED
ARRANGEMENT OF SCRIBE ? BY SSC, INDICATE MEDIUM
- - -
19. LANGUAGE/ MEDIUM OF SKILL TEST 20. POST(S) APPLYING FOR
ENGLISH BOTH (STENOGRAPHER GRADE C AND GRADE D)
21.1 WHETHER SEEKING AGE RELAXATION ? 21.2 IF YES, AGE RELAXATION CODE
NO -
22. HIGHEST EDUCATIONAL QUALIFICATION
BBA (18)
23. DETAILS OF QUALIFYING EDUCATIONAL QUALIFICATION
12TH STANDARD
PASSING STATE/ UT OF NAME OF BOARD/
STATUS ROLL NO PERCENTAGE CGPA
YEAR BOARD/ UNIVERSITY UNIVERSITY
CENTRAL BOARD OF
PASSED 2016 DELHI SECONDARY 6135818 63 -
EDUCATION (CBSE)
24. DO YOU WANT TO MAKE AVAILABLE YOUR PERSONAL INFORMATION FOR ACCESSING JOB OPPORTUNITY IN
TERMS OF DoP&T'S O.M NO.39020/1/2016-ESTT.(B) DATED 21.06.2016 ?
NO
ADDRESS DETAIL
25. CORRESPONDENCE ADDRESS 26. PERMANENT ADDRESS
KALEKTAR BANGLA KE PEECHE JAGDALPUR BASTAR KALEKTAR BANGLA KE PEECHE JAGDALPUR BASTAR
CHHATTISGARH CHHATTISGARH
DISTRICT: BASTAR DISTRICT:BASTAR
STATE: CHHATTISGARH STATE: CHHATTISGARH
PIN : 494001 PIN : 494001
MOBILE NO: 7470969048 EMAIL: paritoshpanigrahi05@[Link]
28. WHETHER PHOTOGRAPH HAS BEEN TAKEN ON OR AFTER 03-MAY-2023?
YES
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
NOT EXEMPTED 100 CPACZDZNF3 09/08/2023
DECLARATION
1. I HAVE READ THE NOTICE OF EXAMINATION AND ACCEPT ALL THE TERMS & CONDITIONS MENTIONED
THEREIN.

2. I HEREBY DECLARE THAT ALL STATEMENTS MADE IN THIS APPLICATION ARE TRUE, COMPLETE AND
CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT IN THE EVENT OF ANY
INFORMATION BEING FOUND SUPPRESSED/FALSE OR INCORRECT OR INELIGIBILITY BEING DETECTED
BEFORE OR AFTER THE EXAMINATION, MY CANDIDATURE/ APPOINTMENT IS LIABLE TO BE
CANCELLED.I AM WILLING TO SERVE ANYWHERE IN INDIA.

3. I DECLARE THAT THE PHOTGRAPH UPLOADED IN APPLICATION FORM IS NOT MORE THAN 3 MONTHS
OLD.

4. I AGREE TO AUTHORIZE SSC TO USE MY AADHAAR DATA FOR VERIFICATION PURPOSE.


*VERIFICATION WILL BE SUBJECT TO AUTHORIZATION FROM COMPETENT AUTHORITY.
PRINT TAKEN ON: 09/10/2023 7:55:49 PM IP ADDRESS:[Link]
NUMBER OF ATTEMPT: 1

You might also like