1/18/2019 e-Application

Closing date:31.01.2019

RECRUITMENT FOR THE POST OF JUNIOR ENGINEER IN ANDAMAN PUBLIC WORKS

DEPARTMENT.

ANDAMAN AND NICOBAR ADMINISTRATION.

APPLICATION FORM

Your Application Number : 16644 Printed on 18-01-2019

Choice of Posts made by candidate.
A. Post Name
1. Junior Engineer(Civil)-01
B. Exam Centre Opted South Andaman
Name of Candidate in BLOCK Letters ( as recorded in SSE (X)
1 PRASUN BAIRAGI
pass certificate) only
2 Father's Name PARESH DAS BAIRAGI
3 Mother's Name JYOTSONA BAIRAGI
4 Gender Male
5 Marital Status Unmarried
(a) Date of Birth ( as recorded in SSE (Xth) pass certificate by
6 10-09-1996
CBSE/Board)
(b) Age as on 31.01.2019 ( completed year and month) (Must
enclose Xth Pass Certificate issued by CBSE/ or any other Board 22 Years and 4 Months
indicating date of birth)
7 Nationality INDIAN
CAMPUS OF GLARE NURSERY SCHOOLINDIRA
8 Permanent Address (Village, Post Office, District and State
NAGAR
Address for communication (Village, Post Office, District and State CAMPUS OF GLARE NURSERY SCHOOLINDIRA
9
with Pin Code ) NAGAR
10 Voters Id Number YFF1404912
11 Mobile Number 7974166267
12 (a) Category Unreserved
Do you possess essential/ minimum educational qualification
13 Yes
viz.Diploma/Degree

14 Educational Qualifications
S.No Name of Exam University/Board Certificate Serial No. Year of passing
1 SENIOR SCHOOL EXAMINATION CBSE 022826 2014
Technical Qualifications
S.No Qualification Board Duration (in Months) Year of Completion
1 Degree in Civil Engineering from a recognized University RGPV 48 2018

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1/18/2019 e-Application

Are you ever employed on regular in any Government Department on regular basis. If yes give
15 No
details with proof. Name of the post being held.
16 Your Employment Exchange Registration Number 00031201800335

17.List of Enclosures
Xth/Secondary School Pass Certificate for Proof of Age
Educational Qualification Certificates
Proof of Identity

I hereby declare that all statements made in this application are true, complete and correct to the best of my knowledge,
information and belief. I understand that in the event of any information being found false or incorrect or ineligibility being
detected at any stage i.e before or after the examination/appointment , my candidature/ appointment is liable to be cancelled. I am
aware that if I contravene this declaration, my candidature will be rejected summarily by the Administration.

I have read the provisions in the Notice of the Administration carefully and I hereby strictly undertake to abide by them.

I further declare that I fulfill all the conditions of eligibility regarding age limits, educational and other qualification etc. prescribed
for appointment to the post.The Qualification Certifcates Enclosed is from an institution recognized by AICTE/Technical Board

I hereby undertake to enclose all the documentary proof, as in S.No.17 above, along with print of this online application and
submit the same to The Executive Officer to Chief Engineer, APWD on or before the prescribed last date i.e 15-02-2019 by 5 pm

Note:The Enclosures must be submitted in hard copy along with the downloaded application to The Executive Officer to Chief
Engineer,Andaman Public Works Department,Nirman Bhawan,PortBlair, Pin-744101.

Place :
Date : 18-01-2019

Signature of the applicant

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