ONLINE APPLICATION REGISTRATION FOR FIELD ASSISTANT 2025
USER ID MRBFAW25000502
POST APPLYING FOR FIELD ASSISTANT
PERSONAL DETAILS
NAME SUGANYA S
NATIONALITY INDIAN
GENDER FEMALE
ARE YOU APPLYING UNDER THE EX-SERVICEMEN NO
CATEGORY?
DO YOU HAVE COMMUNITY CERTIFICATE ISSUED YES
BY TAMIL NADU GOVERNMENT?
COMMUNITY SC
SUB CASTE ADIDRAVIDA
ISSUING AUTHORITY OF COMMUNITY CERTIFICATE TAHSILDAR
COMMUNITY CERTIFICATE NUMBER 4969605
COMMUNITY CERTIFICATE PLACE OF ISSUE VELACHERY
COMMUNITY CERTIFICATE ISSUING DATE 17-JUN-2008
ARE YOU DIFFERENTLY ABLED? NO
ARE YOU A DESTITUTE WIDOW? NO
DATE OF BIRTH (AS PER SSLC MARK SHEET) 18-DEC-1994
AGE AS ON 01-07-2025 30 YEARS 6 MONTHS 13 DAYS
EMAIL ID SARANSUGAN055@[Link]
MOBILE NUMBER 8428761636
WOULD YOU LIKE TO GIVE FATHER AND MOTHER FATHER AND MOTHER
NAME OR GUARDIAN NAME
FATHER'S NAME SURESH
MOTHER'S NAME GANASOUNDARI
ARE YOU MARRIED? YES
NAME OF SPOUSE NIRMAL
NATIVITY CHENNAI - TAMIL NADU
RELIGION HINDU
ARE YOU ALREADY IN GOVERNMENT SERVICE? NO
PHOTO ID PROOF DETAILS
PHOTO ID PROOF DRIVING LICENSE
PHOTO ID PROOF NUMBER TN2220200000155
PERMANENT ADDRESS
ADDRESS NO.44, KAKKAN NAGAR, 4TH CROSS STREET
STATE TAMIL NADU
DISTRICT CHENNAI
CITY / VILLAGE ADAMBAKKAM
PINCODE 600088
Downloaded on 10-12-2025 18:45:41 1
CORRESPONDENCE ADDRESS
ADDRESS NO.44, KAKKAN NAGAR, 4TH CROSS STREET
STATE TAMIL NADU
DISTRICT CHENNAI
CITY / VILLAGE ADAMBAKKAM
PINCODE 600088
MOTHER TONGUE TAMIL
WHETHER ANY CRIMINAL CASE HAVE BEEN FILED NO
AGAINST YOU?
EDUCATIONAL QUALIFICATION
EXAMINATIO NAME OF MONTH & TOTAL TOTAL PERCENTAGE MEDIUM OF CERTIFICATE HAVE YOU
N BOARD YEAR OF MAXIMUM OBTAINED OF MARKS INSTRUCTION ISSUED STUDIED
PASSING MARKS MARKS DATE TAMIL AS
ONE OF THE
LANGUAGE
(PART-1)
10TH / SSLC TAMIL NADU MARCH 500 241 48.20 TAMIL 27- YES
STATE 2011 MAY-2011
BOARD
12TH / HSC TAMIL NADU MARCH 1200 550 45.83 TAMIL 09- YES
STATE 2013 MAY-2013
BOARD
EXAM CERTIF OTHER PERIOD PERIOD DURAT NAME MONTH DO TOTAL TOTAL PERCE MEDI CERTIF HAVE
INATI ICATE EQUIV OF OF ION OF OF & YOU MAXIM OBTAI NTAGE UM ICATE YOU
ON COURS ALENT STUDY STUDY STUDY INSTI YEAR HAVE UM NED OF OF ISSUED STUDI
E QUALIF FROM TO (NUMB TUTIO OF MARKS MARKS MARKS MARKS INSTR DATE ED
NAME ICATIO ER OF N PASSIN FOR UCTIO TAMIL
N YEARS) G THE N AS
CERTIF ONE
ICATE OF
COURS THE
E? LANG
UAGE
(PART-
1)
CERTI OTHER DIPLO 2013 2014 1 YWCA JUNE YES 800 590 73.75 TAMI 20- YES
FICAT EQUIV MA IN OF 2014 L SEP-20
E ALENT HEALT MADR 14
COUR H AS
SE ASSIS COMM
TANT UNITY
COLL
EGE
OTHER QUALIFICATION
DO YOU HAVE ANY OTHER QUALIFICATION? NO
UPLOAD DOCUMENTS
DOCUMENT NAME FILE NAME
COMMUNITY CERTIFICATE [Link]
SSLC CERTIFICATE [Link]
HSC CERTIFICATE [Link]
COURSE CERTIFICATE [Link]
COURSE CERTIFICATE MARKSHEET [Link]
Downloaded on 10-12-2025 18:45:41 2
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 BOARD'S 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.
SUBMITTED DATE : 10-DEC-2025 (SIGNATURE OF THE CANDIDATE)
Downloaded on 10-12-2025 18:45:41 3