Application Form Application Number Token Number 1. Exam Details 1.1 Examination 1.2 Post 1.

3 District Head Quarter for 1.4 Medium of Examination 1.5 Optional Subjects 2. Applicant's Details 2.1 Applicant's Full Name 2.2 Applicant's Father Full Name 2.3 Date Of Birth (dd/mm/yyyy) 2.4 Gender 2.5 Marital Status 2.6 Category 2.7 Home State (Bonafide 2.8 Home District : : : : : : : : AKASH VERMA PRAYAG KUMAR 06/08/1988 MALE Unmarried General DELHI : : : : : RJS COMPETITIVE EXAM 2011 CIVIL JUDGE -JUNIOR DIV AND JUDICIAL MAGISTRATE JAIPUR English : 59011098879 : 1106006110020181 Application Filled Reference Application : 25/08/2011 10.39 PM : 59011098879

Photo & Signature Of Candidate 3. Other Special Categories 3.1 Category for Disabled 3.2 Specific Category for 3.3 Other Category 4. Correspondence Details 4.1 Address : : :

: A-1/125, HASTSAL ROAD, UTTAM NAGAR, DELHI,Tehsil : DELHI,City/Village : DELHI - 110059 Dist : DELHI, State : DELHI

4.2 Email 4.3 Phone 4.4 Mobile 5. Qualification

: sky_super2009@rediffmail.com : : 9810588330

Year

Division/Grade

5.1 Secondary : 2003 5.2 Sr. Secondary : 2005 5.3 Graduation : 2010 5.4 Post Graduation : 6. Additional Qualifications/Specifications 6.1 Other 6.2 Examination passed 6.3 Internship Period 6.4 Experience 7. Identification 7.1 Body Mark 8. Disclaimer : : : From : : Year :

3 2 2

Passed

To : Months : Days :

: MARK ON BODY

I hereby declare that all information made in this application are true, complete and correct to the best of my knowledge and belief. In the event of my information being found false or incorrect or the ineligibility being detected before or after the Screening Test/Interview, action can be taken against me by the Commission. I have read the provisions of the relevant rules and the Advertisement carefully and I hereby undertake to abide by them. I further declare that I fulfill all the conditions of eligibility regarding age limits, educational qualification and required experience etc. prescribed for admission to the Screening Test/Interview. Also I accept SMS facility provided by the Commission.

Rajasthan Public Service Commission Ghooghara Ghati, Jaipur Road, Ajmer Phone : +91+145+ 5151200, 5151240 & 5151090

Nodal Officer: Mr. G.S.Tilwani, Asstt. Sect. (0145-5151218)