5/18/2017 TeachersRecruitmentBoard

ApplicationNo. 162393

Candidate'sName SKARTHIKEYAN

DateofBirth 15/03/1980

Age(Ason1st July,2017) 37years,3months,and17days

Gender Male

Community SCA

Father'sName SRINIVASANK
Mother'sName VANITHAMANIR
Areyoudifferentlyabled? No
EmailID karthi_siva2001@yahoo.com
MobileNo. 9952742885

NameOfExam Board/University MediumOfInstruction Month&YearOfPassing

SSLC StateBoard Tamil 031996

HSC StateBoard Tamil 031998

UG UNIVERSITYOFMADRAS Tamil 072003

PG VINAYAKAMISSIONUNIVERSITY English 012010

B.Ed. THIRUVALLUVARUNIVERSITY Tamil 042007

Haveyoudoneanyoftheprescribedqualifications(UG/PG/B.Ed.)asan
No
integratedcourse?
Postappliedfor Chemistry
SubjectstudiedinUGDegree/IntegratedPGDegree Chemistry
SubjectstudiedinPGDegree/IntegratedPGDegree Chemistry
Doyouhavehighersecondaryclassteachingexperienceinthepost
appliedfor,aftercompletingalltherequiredqualificationsforthepostof No
PGAssistant?
HaveyouregisteredinProfessional&ExecutiveEmploymentExchange
Yes
aftercompletingalltherequiredqualificationsforthepostofPGAssistant?
DateofRegistrationinProfessional&ExecutiveEmploymentExchange
02/09/2011
aftercompletingalltherequiredqualificationsforthepostofPGAssistant.
ChoiceofExamDistrict Thiruvannamalai
AddressforCommunication
aAddress1 122INDIRANAGAR
bAddress2 NALLAVANPALAYAM
cAddress3 TIRUVANNAMALAI
District TIRUVANNAMALAI
State TamilNadu
PinCode 606603
FeePaymentDetails

a.TransactionNumber212427400 b.DateofTransaction2017051810:01:59 c.Amount250.00(ConvenienceCharges&ServiceTaxasapplicable)

Declaration
1.Ihavegonethroughtheinstructionstothecandidatesandtheboard'snotificationforthisrecruitmentbeforefillinguptheapplicationform.
2.Iherebydeclarethatalltheparticularsfurnishedinthisapplicationaretrue,correctandcompletetothebestofmyknowledgeandbelief.
3.Iamawarethatintheeventofanyinformationbeingfoundfalseorincorrectatanystageormyineligibilitybeingdetectedatanytime,TRBisatlibertytodisqualifymycandidatureat
anystageandalsocancelmyselection,ifmade.
4.IherebydeclarethatIwillnotbeapartytoanykindofcanvassingonmybehalf.
5.Iwillproducethenecessarycertificatesordocumentaryproofrelatedtotherecruitmentatthetimeofcertificateverification,ifcalledforanduponselectionorthereafter.
6.Ihaveverifiedthecorrectnessoftheparticularsfurnishedintheapplicationandwilltakeaprintoutoftheapplication.

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