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GOVERNMENT OF PUDUCHERRYDepartment of Revenue and Disaster Management

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Application for Recruitment to the post of VILLAGE ADMINISTRATIVE OFFICER

(Pay Band - 1: `5200-20200 with Grade Pay: `2400/-)

17629

POST APPLIED

Name of the Post Code Number

VILLAGE ADMINISTRATIVEOFFICER

01

Applicant's Specimen Signature:

1. Application Number : 17629

2. Name of the Applicant : Mr. RADHAKRISHNAN A

3. Father's Name : ARUMUGAM

4. Mother's Name : LAKSHMI

5. Spouse's Name (if married) : PREMILADEVI

6. Date of Birth : 21/04/1988

7. Age as on 22/01/2014 : 25 years and 9 months

8. Gender : Male

9. Address :

Address for Communication Permanent Address

NO. 13, SK STREETKONERIKUPPAMKOODAPAKKAMPUDUCHERRY - 605502

NO. 13, SK STREETKONERIKUPPAMKOODAPAKKAMPUDUCHERRY - 605502

10. Mobile Number : +919786484828

11. E-Mail Id : krish.radha21@gmail.com

12. Educational Qualifications :

Sl.No.

Qualification Name of the BoardMonth & Year

of Passing

1 SSLC or equivalent STATE BOARD OF TAMILNADU Mar, 2005

2H.Sc / 3 years Diploma orequivalent

DIRECTORATE OF TECHNICALEDUCATION

Apr, 2011

13. Technical Qualifications :

Name of theCourse

Duration of Course(in Months)

Month & Year ofPassing

Name of theInstitution

Wether recognizedby Government

DCA 3 Jul, 2005RV COMPUTER

EDUCATIONYes

14. Nationality : INDIAN

15. Whether Native / Resident of Puducherry : Yes

16. Religion : HINDU

17. Have Regd in Emp Exchange? : No

18. Community : MBC - Origin

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DECLARATION

I have read the provisions in the Notification of the examination carefully and hereby undertake to abideby them.

I declare that I am a Native / Resident of Union Territory of Puducherry by virtue of continuous

residence for the last five years immediately preceding the date of Notification and I understand that any

deviation in this regard will render my selection invalid.

I have not submitted any other application for this examination. I am aware that if I contravene this, my

application will be summarily rejected.

I further declare that I fulfill all the conditions of eligibility regarding age limits, educational

qualification, technical qualification etc., prescribed for admission to the examination.

I also declare that I have never been convicted by any court of law. I also declare that no charge sheet is

pending against me in any court of law.

I understand that success in examination confers no right to appointment. I further understand that

appointment is subject to fulfillment of all conditions stipulated in the Notification.

I hereby declare that all statements made in this application are true, complete and correct to the best of

my knowledge and belief. I understand that in the event of any information being found suppressed / false or

incorrect or ineligibility being detected before or after the examination, my candidature / appointment is

liable to be cancelled.

19. Category : Not Applicable

20. Examination Centre : PUDUCHERRY

21. Medium of Examination Opted : ENGLISH and TAMIL

22. Examination Fee :

Name of the Bank Amount Demand Draft Number Demand Draft Date

SBI `50/- 539743 26/12/2013

23. Ration Card Number : 360466

24. EPIC / Voter ID Number :

25. Certificates :

Certificate Name Certificate Number Date Issued Taluk Office

PIC ----- ----- -----

Residence / Nativity ----- ----- -----

Caste ----- ----- -----

DATE: 12/01/2014

PLACE: PUDUCHERRY SIGNATURE OF THE APPLICANT

Note:

Unsigned application will be rejected.

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