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    SLRC Class Iii

    Uploaded by

    Mozibor

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    SLRC Class Iii

    Uploaded by

    Mozibor
    7 views2 pages

    Original Title

    SLRC CLASS III

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    Copyright:

    © All Rights Reserved
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    7 views2 pages

    SLRC Class Iii

    Uploaded by

    Mozibor

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    STATE LEVEL COMMISSION FOR CLASS III POSTS

    State Level Recruitment Commission for Class III


    Online Application form for Recruitment of Class III posts under Government of Assam
    Application No. 2210002637

    B- For the posts where minimum qualification is with


    Graduate Degree with Diploma or Degree in Computer YES
    Science
    Type of posts applied for

    Full name of the Applicant MOZIBOR RAHMAN


    Name of Father/ Guardian ABDUS SALAM
    Name of spouse of the Applicant
    Name of mother of the Applicant AZIDA KHATUN
    Applicant DOB 15/06/1993
    Gender MALE
    Registration Number of Employement Exchange 8079894/10/2021
    Category GENERAL
    EWS NO
    Are You Divyang (Physically Challenged) NO
    Ex-Serviceman NO
    Nationality INDIAN
    Religion MUSLIM
    Permanent Address Information RAMHARIR CHAR PTIII
    JOYPUR BAZAR
    GOALPARA RPS
    GOALPARA
    GOALPARA RPS
    783129
    GOALPARA
    Name of Revenue circle BALIJANA
    Name of Dev block of panchayat department/ Municipal board/
    KHARMUUZA DEVELOPMENT BLOCK
    Town committee
    Present Address Information

    04-ASSAM
    Mobile Number 7635909810
    E-Mail MOZIBORMR@GMAIL.COM Aadhar Card number 524782493810
    Choice of District for appearing in written Exam :
    Preference 1 KAMRUP METRO
    Preference 2 KOKRAJHAR
    Preference 3 BAJALI
    Qualification details ( All Degrees must be acquired from recognized University/Board )
    Marks Total % of Year Of
    Course Stream Name of School Name of Board
    Obtained Marks Marks Passing
    HSLC or equivalent RAKHALDUBI HIGH
    369 600 61.50 2010 SEBA
    examination passed MADRASSA
    HSSLC or equivalent P.R GOVT HS & MP
    SCIENCE 367 500 73.40 2012 AHSEC
    examination passed SCHOOL,GLP
    Graduate degree BSC 1111 1700 65.35 2015 GOALPARA COLLEGE GAUHATI UNIVERSITY
    SMART EDUCATION
    Diploma in Computer Science 1YEAR 350 500 70.00 2013 NYK,GOALPARA
    CENTRE
    Other higher qualification ,if SWAMI VIVEKANANDA
    THE BURDWAN
    any,professional qualification B.ED 1500 2000 75.00 2019 UNIVERSAL COLLEGE OF
    UNIVERSITY
    etc EDUCATION
    Choose the Medium of
    Instruction for the Question ENGLISH
    Booklet of Written Test
    Do you have Typing
    NO
    Certificate
    Do you have short Hand
    NO
    Typing Certificate
    Details of Driving license
    Do you have Driving License NO
    Payment Details
    Bank Reference No. WAX61074269684
    Fees Paid 350.00
    Declaration :
    I declare that the above entries in the Application Form have been filled up by myself and the entries made are correct as per my
    documents and to the best of my knowledge and belief. I agree that if any statement is proved to be false then the Authority shall
    have the right to take legal action against me and also cancel the application for submitting false information of statement.
    I further declare that there is no allegation of misconduct against me and I have never been convicted for any offence involving moral
    turpitude or criminal offence under any laws of the land.

    Date : ______________
    Place : _____________
    Signature of the Applicant

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