SARVA SHIKSHA ABHIYAN TELANGANA, HYDERABAD. DISTRICT PROJECT OFFICE, ………………………. DISTRICT APPLICATION (Last date for submission of application ………………) Affix Passport size Photo duly attested by any Gazetted Officer : MIS Coordinator / Data Entry

1. Post Applied for Operator 2. Name of the applicant

:

3. Father’s Name

:

4. Date of Birth

:

5. Age (As on 01-07-2014)

:

6. Community

: SC/ ST/ BC/ OC :Sub Caste:

7. Place of Birth

:

8. Native Mandal&District

:

Group: (

)

9. Qualifications : a) Academic

: Degree

b) Technical / Others

Main Subjects

:

10. Marks Secured Course Graduation PGDCA

Subjects Studied

Maximum Marks

Marks Secured

Percentage %

11. Address for correspondence with Contact No.

:

12. Any other information if any

:

ENCLOSURES Enclosures(Attested by Gazetted Officer)www.prafulstu.com SSC

Whether enclosed certified copy(Yes/No)

Graduation PGDCA Caste Certificate Nativity certificate / study certificate (IV to X class) Any other information The candidate shall bring all the relevant original certificates as mentioned above for verification purpose. Declaration I hereby declare that the above information furnished by me is true to the best of myknowledge. If any information is found incorrect, my application may be rejected. Signature of the Applicant

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