Tamil Nadu Public Service Commission த"# நா& அர)p ப,யாளr ேதrவாைணயm

Name of the Post Applying for / !"ணpπk'm பத!+, ெபயr :POSTS INCLUDED IN COMBINED CIVIL SERVICEEXAMINATION-II (NON-INTERVIEW POSTS)(GROUP-II ASERVICES)

Notification No. / அ1!kைக எ" : 17/2015

Application No. / !"ணpப எ" : 517523160

Registration Date : / ப56 ெசyத நாll : 07-11-2015 17:50:43

Name of the Candidate / !"ணpபதார=, ெபயr :Initialsதைலpெப?tAகll

Nameெபயr

S SIDHARTH

Gender / பாBனm : MALE

Date of Birth / πறnத ேத5 : 10-11-1993

Father's Name / தnைதயாr ெபயr :Initialsதைலpெப?tAகll

Nameெபயr

S SYED IBRAHIM

Mother's Name / தாயாr ெபயr :Initialsதைலpெப?tAகll

Nameெபயr

S ARULSELVI

Marital Status / 5Gமணm ஆனவரா? UNMARRIED

Candidate's Place of Birth / !"ணpபதாரr πறnத இடm : DHARMAPURI

Native District / ெசாnத மாவMடm : DHARMAPURI

Father's Place of Birth / தnைதயாr πறnத இடm : RAMANATHAPURAM

Mother Tongue / தாy ெமாN : TAMIL

Nationality / ேதOய இனm : INDIAN

Religion / மதm : MUSLIM

Certificate Details / சா67த#க96 :வரŋகll

Communal Category / வ'pP : BACKWARD CLASS-MUSLIM(BCM)

Name of the Sub - Caste / சா5 உMπ=!,ெபயr :

LABBAIS

Certif icate No / சா,1தR எ" : 5723656Date of Issue / வழŋகpபMட ேத5 : 06-06-2003Issuing Authority / சா,1தR வழŋUய அ5கா=:

ZONAL DEPUTYTAHSILDAR

District / மாவMடm : SALEMTaluk / வMடm : SALEM

Are you a Differently Abled Person / மாVWt 5றனாXயா ? NO

Are you a Government Employee / அரYpபZயாளரா ? NO

Have you been debarred or disqualif ied by the Public ServiceCommission or any other recruiting agency from appearing

examinations and selections for specific period or permanently? /ேதrவாைணயm அlலA ேவW எnத பZ ]யமன µகைம+னாேலா ேதr6கll மVWm

ெத=6கXl கலnA ெகாll_m உ=ைம+BGnA தŋகைள ]ரnதரமாகேவா அlலA ஒG'1pπMட காலt5Vேகா !லkU ைவtேதா அlலA த'5+,ைமேயா ெசyயpபMallளதா

?

NO

Are you an Ex-Servicemen / µ,னாll இராbவt5னரா? NO

Criminal Case Registered / 'Vற!யl வழk' ப5யpபMடதா ? NO

Participation in Polit ical Activit ies / அரOயBl பŋேகVP ? NO

Communication Details / ெதாடr? @7tத :வரŋகll

Correspondence Address / ெதாடrP µகவ= Permanent Address / ]ரnதர µகவ=

Address Line 1 / µகவ= 1 : 23/2 APPAVOO NAGARAddress Line 2 / µகவ= 2 : BHARATHIYAR STREETAddress Line 3 / µகவ= 3 : SURAMANGALAM

Address Line 1 / µகவ= 1 : 23/2 APPAVOO NAGARAddress Line 2 / µகவ= 2 : BHARATHIYAR STREETAddress Line 3 / µகவ= 3 : SURAMANGALAM

State / மா]லm : TAMIL NADUDistrict / மாவMடm : SALEM

Pincode / அcசl '1da : 636005

State / மா]லm : TAMIL NADUDistrict / மாவMடm : SALEM

Pincode / அcசl '1da : 636005

Email ID / e,னcசl µகவ= : ohmysid@gmail.com

Mobile No / ைகேபO எ" : 8056789708

Educational Qualification Particulars / கl:t த@C @7tத :வரŋகll

SSLC

Date of Result Published / ேதr6 µf6 ெவX+டpபMட ேத5 : 30-05-2008Medium of Instruction / ப+VW ெமாN : ENGLISHName of the Board / University / ேதr6k'?மm /பlகைலkகழகm : MATRICULATIONCertif icate Number / சா,1தR எ" : 0045899Whether studied Tamil as one of the subject / தeைழ ஒG பாடமாக எatA ேதrcOெபVWllhரா?

YES

HSC

Date of Result Published / ேதr6 µf6 ெவX+டpபMட ேத5 : 14-05-2010Medium of Instruction / ப+VW ெமாN : ENGLISHName of the Board / University / ேதr6k'?மm /பlகைலkகழகm : STATE BOARDCertif icate Number / சா,1தR எ" : 4919217Whether studied Tamil as one of the subject / தeைழ ஒG பாடமாக எatA ேதrcOெபVWllhரா?

YES

Under Graduate

Date of Result Published / ேதr6 µf6 ெவX+டpபMட ேத5 : 02-05-2014Name of the Degree / பMடp பfpπ, ெபயr : OTHER THAN ABOVE DEGREESSpecify the Degree with Major Subject B.TECH BIOTECHNOLOGYName of the Board / University / ேதr6k'?மm /பlகைலkகழகm : KUMARAGURU COLLEGE OF TECHNOLOCertif icate Number / சா,1தR எ" : CK01966Whether studied Tamil as one of the subject / தeைழ ஒG பாடமாக எatA ேதrcOெபVWllhரா?

NO

Medium of Instruction / ப+VW ெமாN : ENGLISH

Do you have the Physical Standards as per notif ication? / அ1!kைக+l'1pπMallள உடVத'5 ெபVWllhரா? :

YES

*Have you passed the Certif icate course in Computer on OfficeAutomation awarded by the Technical Education Department. / NO

Examination Particulars / ேதr:6 :வரŋகll

Name of the Examination Centre / ேதr6 ைமயt5, ெபயr : SALEM

Subject(s) for Examination / ேதr!Vகான பாடm :GENERAL STUDIES (DEGREE STANDARD) AND GENERALENGLISH (SSLC STANDARD)

Registration Fees

*Payment Mode ONLINETRANSACTION ID : CP32488739 FEES AMOUNT : 75

Declaration / உEC ெமாG

I hereby declare that al l the particulars furnished in this application are true, correct and complete to the best of my knowledge and belief. Inthe event of any information being found false or incorrect or ineligibil ity being detected before or after the examination, action can be takenagainst me by the TNPSC. இv!"ணpபt5l '1pπMallள !வரŋகளைனtAm எ, அ1!V' எMfயவைர உ"ைமயானA , ச=யானA மVWm µ?ைமயானA . ேதr!V' µ,ேபா அlலA πறேகாஇv!வரŋகll தவW அlலA உ"ைமk'p PறmபானA அlலA த'5+,ைம என அ1jmபMசt5l எ,kA எakகpபam ேதrவாைணயt5, எv!த நடவfkைகk'm உMபaUேற, .

I hereby declare that I wil l not be a party to any kind of canvassing on my behalf. எ, சாrπl எnத !தமான ஆதரைவjm நாட நா, உடnைதயாக இGkகமாMேட, .

I further declare that I fulfi l al l the eligibil ity conditions prescribed for admission to the examination. இtேதr!, அlம5k't ேதைவயான அைனtAt த'5கைளjm ெபVWllேள, என உW5 mWUேற, .

I have gone through the instructions to the candidates and the Commission's notif ication for this Recruitment before fi l l ing up the applicationform. ேதrவாைணயt5, "!"ணpபதாரrக_kகான !5µைறகll" மVWm இpபத!kகாக !ளmபரpபatதpபMallள அ1!kைக+ைனjm பftA அ1nத π,ேப இv!"ணpபtைதpnrt5 ெசyAllேள, .

I declare that I possess the Physical standards prescribed for the post(s) which I am now applying. !"ணpπk'm பத! அlலA பத!க_k't ேதைவயான உடV த'5கைளp ெபVWllேள, எ,W உW5யXkUேற, .

I Certify that I have not been debarred / disqualif ied by the TNPSC or any other recruiting agency. இtேதrவாைணயtதாேலா அlலA ேவW எnத பZ ]யமன µகைமகளாேலா நா, !லkUைவkக அlலA த'5okகm ெசyயpபட!lைல எனc சா,றXkUேற, .

I am not a dismissed Government Employee. நா, பZயற6 ெசyயpபMட அரYpபZயாள, அlல, .

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