ONLINE APPLICATION REGISTRATION FOR HEALTH INSPECTOR

GRADE - II 2025

USER ID MRBHI25001926
POST APPLYING FOR HEALTH INSPECTOR GRADE - II

PERSONAL DETAILS
NAME YUVANSAKAR R
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 SOZHIAVELLALAR INCL. SOZHAVELLALAR/VETRILAIKARAR/KODIKALKARAR &
KEERAIKARAR
ISSUING AUTHORITY OF COMMUNITY CERTIFICATE ZONAL DEPUTY TAHSILDAR
COMMUNITY CERTIFICATE NO TN-520180707414
COMMUNITY CERTIFICATE PLACE OF ISSUE KRISHNARAYAPURAM
COMMUNITY CERTIFICATE ISSUING DATE 23-JUL-2018
ARE YOU DIFFERENTLY ABLED? NO
HAVE YOU ALREADY APPLIED FOR THIS HEALTH NO
INSPECTOR GRADE - II POST AS PER NOTIFICATION
NO. 06/MRB/2023, DATED: 11.07.2023?
DATE OF BIRTH (AS PER SSLC MARK SHEET) 27-MAY-2005
AGE AS ON 01-07-2025 20 YEARS 1 MONTHS 4 DAYS
EMAIL ID YUVANSANKARVIJAY@[Link]
MOBILE NO 9790550481
WOULD YOU LIKE TO GIVE FATHER AND MOTHER FATHER AND MOTHER
NAME OR GUARDIAN NAME
FATHER'S NAME RAMESH A
MOTHER'S NAME GOWRI R
ARE YOU MARRIED NO
NATIVITY KARUR - TAMIL NADU

GENDER MALE
RELIGION HINDU
ARE YOU ALREADY IN GOVERNMENT SERVICE? NO

PHOTO ID PROOF DETAILS

PHOTO ID PROOF NO. UPX2015881

PERMANENT ADDRESS
ADDRESS 3/592, KODIKKALSTREET, KALLAPALLI, LALAPET
STATE TAMIL NADU

05-12-2025 21:01:02 1
 DISTRICT KARUR
CITY / VILLAGE KRISHNARAYAPURAM
PINCODE 639105

CORRESPONDENCE ADDRESS
ADDRESS 3/592, KODIKKALSTREET, KALLAPALLI, LALAPET
STATE TAMIL NADU
DISTRICT KARUR
CITY / VILLAGE KRISHNARAYAPURAM
PINCODE 639105

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 - 29-
BOARD 2019 APR-2019
12TH / HSC TAMIL NADU STATE - - BOTANY AND MAY 2021 TAMIL YES 19-
BOARD ZOOLOGY JUL-2021

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 - 2021 2024 3 SUBBASAK JANUARY ENGLISH NO 05-
TE YEARS THI 2024 JAN-2024
COURSE MULTIPUR INSTITUTE
POSE OF
HEALTH PARAMEDI
WORKER CAL
(MALE) SCIENCE
COURSE KULITHALA
I
ARE YOU ELIGIBLE TO AVAIL PSTM PREFERENCE? NO

OTHER QUALIFICATION
DO YOU HAVE ANY OTHER QUALIFICATION? NO

COVID DUTY CERTIFICATE

UPLOAD DOCUMENTS
DOCUMENT NAME FILE NAME
COMMUNITY CERTIFICATE [Link]
SSLC CERTIFICATE [Link]

05-12-2025 21:01:02 2
 DOCUMENT NAME FILE NAME
HSC CERTIFICATE [Link]
COURSE CERTIFICATE [Link]

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 : 28-OCT-2025 (SIGNATURE OF THE CANDIDATE)

05-12-2025 21:01:02 3