Chennai Metropolitan Water Supply and Sewerage Board

Application Form

POST - ASSISTANT ENGINEER CIVIL / MECH.

Applicant Details : Applied On : 04/03/2017 10:25:23
REFERENCE ID. : CMWSSB050606

APPLICATION NUMBER : 150552

APPLICANT NAME : RAJA M

FATHER'S/HUSBAND'S NAME : MURUGAN K N

MOTHER'S NAME : SUMATHI M

DATE OF BIRTH : 11/06/1992

AGE OF APPLICANT : 25Years 0Months 21Days Affix your

re ce nt passport size
PLACE OF BIRTH : GOBICHETTIPALAYAM colour photograph

GENDER : MALE

NATIONALITY : INDIAN

RELIGION : HINDU

COMMUNITY : MBC/DNC

STUDIED IN TAMIL MEDIUM : NO

CANDIDATE BELONGS TO : YES

TAMILNADU

DIFFERENTLY ABLED PERSON : NO

MOBILE NUMBER : 9786375458

E-MAIL ID : RAJACIVILIAN92@GMAIL.COM

TEST LOCATION : COIMBATORE

DESTITUTE WIDOW : NO

EX-SERVICEMAN/ARMY : NO

PERSONNEL'S DEPENDENTS

PRIORITY DETAILS

COME UNDER PRIORITY : NO

PAYMENT DETAILS

PAYMENT MODE : ONLINE PAYMENT

PAYMENT TRANSACTION ID : 27330815 FEE AMOUNT : Rs. 500/-
PAYMENT
PAYMENT DATE : 04/03/2017 PAYMENT STATUS :
SUCCESS

PERMANENT ADDRESS CORRESPONDENCE ADDRESS

ADDRESS : 43/52, THIPPU SULTHAN ROAD ADDRESS : 43/52, THIPPU SULTHAN ROAD
 NORTHPET NORTHPET
SATHYAMANGALAM, ERODE(DT) SATHYAMANGALAM, ERODE(DT)
CITY : ERODE CITY : ERODE

STATE : TAMIL NADU STATE : TAMIL NADU

PINCODE : 638401 PINCODE : 638401

LANDLINE NO. : 9786375458 LANDLINE NO. :-

EDUCATIONAL QUALIFICATION

Second Language in SSLC : TAMIL

Second Language in PUC / HSC (+2) : TAMIL
REQUIRED QUALIFICATION *
MONTH & PASS
UNIVERSITY / MODE OF MAX OBTAINED
QUALIFICATION YEAR (MM/YYYY PERCENTAGE CERTIFICATE NO.
INSTITUTION STUDY MARKS MARKS
FORMAT)
SSLC STATE BOARD OF
REGULAR 03/2007 1100 694 63.091 0656462
MATRICULATION
H.S.C (+2) STATE BOARD OF
REGULAR 03/2009 1200 1117 93.083 0899705
SCHOOL
B.E/ B.TECH/AMIE- ANNA
REGULAR 05/2013 10 7 70.000 4013053
CIVIL ENGG UNIVERSITY

Other Details

Whether change of name made ? : NO

Are you employed in any other Govt. Dept. / Statutory
: NO
Bodies / Public Sector Undertakings
Is any Police cases pending : NO
Police cases details to come here :

information regarding arrest, convictions / debarment /

: NO
disqualifications
if yes details to come here :
NOTE: All relevant xerox copy along with original should be produced at the time of certificate verification.

DECLARATION
I hereby declare that all the statements made in this application are true andcomplete to the best of my knowledge and
belief and nothing has beenconcealed/distorted.I am aware that, if at any time I am found to haveconcealed/distorted any
material information, my appointment is liable to besummarily terminated without notice. Moreover, if any information is
found incorrect/wrong, I shall be liable for action as decided by the University authority.

Place:

Date: (Signature of the Candidate)