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Ministry of Home Affairs,Govt. of India Print Back Post Applied For : SECURITY ASSISTANT/EXECUTIVE Applicant's Registration No :MHA401052501 Personal Information: Applicant's Name: SATYENDRA KUMAR MEENA Your Photo Father's /Mother's Name: THANDIRAM MEENA Relationship: FATHER Gender: MALE Date Of Birth: 1/7/1991 Category: ST Religion: HINDU Others Religion: Are you a Central Govt. Employee? : NO Nationality: INDIAN State of Domicile: RAJASTHAN Are you an Ex-Serviceman? NO Domicile of J&K during the period 01.01.1980 to 31.12.1989 : NO Are you a victim of Gujarat riots 2002? : NO Qualification Details: Name of Educational Qualification: BTECH Month & year of Passing: Month: JULY Year: 2013 Duration of the Course: Years: 4 Months: 0 College/Institute Name INDIAN INSTITUTE OF TECHNOLOGY KHARAGPUR Name of University affiliated: INDIAN INSTITUTE OF TECHNOLOGY KHARAGPUR Recognized by State/Central Govt.: CENTRAL Additional Qualification (if any) : YES Name of Qualification : COMPUTER KNOWLEDGE Details : COMPUTER KNOWLEDGE Choice of Examination Center: JAIPUR Local Language/Dialect : RAJASTHANI :Read - YES, Write - YES, Speak - YES Additional Information: Contact No. (Only Digits): 919654047104 Alternate Mobile No. (if any): 91 Email ID: [email protected] Alternate Email ID (optional): [email protected] Address Line 1: VILLAGE SURAIR Address Line 2: TESHIL SIKRAI Address Line 3: DAUSA City/Town: DAUSA PIN: 303509 State: RAJASTHAN Home State: RAJASTHAN Are you prepared to serve anywhere in India? YES Declaration I hereby declare that the the information given above is true and correct to the best of my knowledge and I fulfill the eligibility conditions for appearing in the recruitment test conducted by Ministry of Home Affairs(MHA) for the post of SA/Exe. I further declare that in case any of the above information is found to be false/incorrect or any ineligibility being detected before, during or after the test, my candidature for the post of SA/Exe is liable to be forfeited. (Applicant's Signature)

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Page 1: Https Www.onlinesubmit.in Mha4 RegisteredUsers CompleteApplication

Ministry of Home Affairs,Govt. of India Print Back

Post Applied For : SECURITYASSISTANT/EXECUTIVE

Applicant's Registration No :MHA401052501

Personal Information:

Applicant's Name: SATYENDRA KUMAR MEENA Your Photo

Father's /Mother's Name: THANDIRAM MEENA

Relationship: FATHER Gender: MALE Date Of Birth: 1/7/1991

Category: ST Religion: HINDU Others Religion:

Are you a Central Govt. Employee? : NO

Nationality: INDIAN State of Domicile: RAJASTHAN

Are you an Ex-Serviceman? NO

Domicile of J&K during the period 01.01.1980 to 31.12.1989 : NO

Are you a victim of Gujarat riots 2002? : NO

Qualification Details:

Name of Educational Qualification: BTECH

Month & year of Passing: Month: JULY Year: 2013 Duration of the Course: Years: 4 Months: 0

College/Institute Name INDIAN INSTITUTE OF TECHNOLOGY KHARAGPUR

Name of University affiliated: INDIAN INSTITUTE OF TECHNOLOGY KHARAGPUR

Recognized by State/Central Govt.: CENTRAL

Additional Qualification (if any) : YES

Name of Qualification : COMPUTER KNOWLEDGE Details : COMPUTER KNOWLEDGE

Choice of Examination Center: JAIPUR

Local Language/Dialect : RAJASTHANI :Read - YES, Write - YES, Speak - YES

Additional Information:

Contact No. (Only Digits): 919654047104 Alternate Mobile No. (if any): 91

Email ID: [email protected] Alternate Email ID (optional): [email protected]

Address Line 1: VILLAGE SURAIR

Address Line 2: TESHIL SIKRAI

Address Line 3: DAUSA

City/Town: DAUSA PIN: 303509 State: RAJASTHAN

Home State: RAJASTHAN

Are you prepared to serve anywhere in India? YES

Declaration

I hereby declare that the the information given above is true and correct to the best of my knowledge and I fulfill the eligibility conditionsfor appearing in the recruitment test conducted by Ministry of Home Affairs(MHA) for the post of SA/Exe. I further declare that in case anyof the above information is found to be false/incorrect or any ineligibility being detected before, during or after the test, my candidaturefor the post of SA/Exe is liable to be forfeited.

(Applicant's Signature)