1. The document is an online registration form for the recruitment of Group C paramedical posts in the Employees' State Insurance Corporation filled out by Durgesh Kumar Son. 2. Durgesh Kumar Son is applying for the post of OT Assistant in the Delhi NCR region. He is 35 years old and has over 13 years of experience working as an OT Technician at Shri Krishna Hospital in Agra. 3. In the registration form, Durgesh provides personal details like contact information, education qualifications including a diploma in OT Technology, and work experience details among other information required for the application.

1. 10/30/23, 7:49 PM RECRUITMENT OF GROUP ‘C’ PARAMEDICAL POSTS
https://ibpsonline.ibps.in/esicjan23/registration_print.php?q=MDQxNzkzOGQzNzE4OTVhZDQyZDc2Njk3MzVhMjNhMTZ8MjU4MTIzMDQw# 1/4
Registration Number : 258123040
Full Name : DURGESH KUMAR SON
Post : OT Assistant
Region : Delhi NCR
Category : SC
Are you a person with benchmark disability of
40% and above ?
: NO
Disability category : -
Type of Disability : -
Do you need compensatory time at the time of
examination?
: -
Are you suffering from cerebral palsy and your
writing speed is affected?
: -
If Yes, Do you need compensatory time at the
time of examination?
: -
Whether your dominant (Writing) hand is
affected?
: -
If Yes, Do you need compensatory time at the
time of examination?
: -
Do you intend to use the services of a scribe ? : -
Are you a person with specified disability covered
under the definition of sec 2(s) of the RPwD Act,
2016 and not covered under sec 2(r) of the said
act and having difficulty in writing?
: NO
If Yes, Do you need compensatory time at the
time of examination?
: -
Are you a person with specified disability covered
under the definition of sec 2(s) of the RPwD Act,
2016 and not covered under sec 2(r) of the said
act and wish to avail the services of Scribe?
: -
I certify that, I will produce the certificate from
competent medical authority of a Government
healthcare institution as per Ministry of Social
Justice and Empowerment, Department of
Empowerment of Persons with Disabilities
(Divyangjan) circular no F. No. 29-6/2019-DD-III
dated 10.08.2022.
: -
Whether scribe will be brought by candidate ? : -
Do you need scribe from Employees’ State
Insurance Corporation ?
: -
Do you belong to Religious Minority ? : NO
Are you ESIC Employee/ Government Servant
who have rendered not less than 3 years regular
and continuous service as on closing date for
receipt of application : ?
: NO
EMPLOYEES’ STATE INSURANCE CORPORATION
RECRUITMENT OF GROUP ‘C’ PARAMEDICAL POSTS
360125

2. 10/30/23, 7:49 PM RECRUITMENT OF GROUP ‘C’ PARAMEDICAL POSTS
https://ibpsonline.ibps.in/esicjan23/registration_print.php?q=MDQxNzkzOGQzNzE4OTVhZDQyZDc2Njk3MzVhMjNhMTZ8MjU4MTIzMDQw# 2/4
Kindly Specify : -
Are you a regular ESIC employee seeking
relaxation in fee ?
: -
Are you an Ex-Serviceman : ? : NO
Period of Service ( in months) : -
Ex-Servicemen who have already secured
employment in civil side under Government in
Group ‘C’ & ‘D’ posts on regular basis after
availing of the benefits of reservation given to ex-
servicemen
: -
Any other category for relaxation in age : NO
Mention category for age relaxation : -
Nationality : Indian
State/UT to which centre of Online examination
belongs
: Uttar Pradesh
Centre of Online Examination : Agra
Application Fee / Intimation charges
Payment In : ONLINE
Amount : 250.00
Payment Status : PAID
Reference ID : YHMP2127976817
Transaction Date : 30-10-2023
Do you want to receive refund of fees in the
same channel by which you are paying fees ?
: YES
Account Number : -
Account Type : -
Bank Name : -
Branch Name : -
IFSC Code : -
Name of the Account Holder : -
Personal Details
Date of Birth : 12-07-1988
Age completed as on 30.10.2023 : 35
Gender : MALE
Do you have twin brother / sister ? : NO
Name of the twin : -
Gender of the twin : -
Marital Status : Married
Father's Name : SURESH SON
Mother's Name : SHYAM WATI SON
Spouse's Name : MADHU
Address for Correspondence
Address 1 : 35
Address 2 : NH 2 KUBERPUR
Address 3 : AGRA
District : AGRA
State : UTTAR PRADESH
Pincode : 282006
Permanent address

3. 10/30/23, 7:49 PM RECRUITMENT OF GROUP ‘C’ PARAMEDICAL POSTS
https://ibpsonline.ibps.in/esicjan23/registration_print.php?q=MDQxNzkzOGQzNzE4OTVhZDQyZDc2Njk3MzVhMjNhMTZ8MjU4MTIzMDQw# 3/4
Languages Known Read Write Speak
HINDI YES YES YES
ENGLISH YES YES YES
1. Left Thumb Impression
2. Hand Written Declaration
Address 1 : 35
Address 2 : NH 2 KUBERPUR
Address 3 : AGRA
District : AGRA
State : UTTAR PRADESH
Pincode : 282006
Contact Details
Mobile No : +91 7906567993
Alternative Number
(Mobile No/Landline No)
: -
Email ID : durgeshkumarson0562@gmail.com
Educational Qualification (as on 30.10.2023)
Exam Passed Degree/ Subject /
Stream
Duration of
Course (in years)
Date of
Passing
% of Marks Class / Grade
Matriculation/10th SCIENCE - 31-05-2004 48.00 Pass Class
HSC/12th or Equivalent Science - 31-05-2006 57.80 Second Class
Diploma Others - OT
TECHNICIAN
2 14-11-2008 56.33 Second Class
Do you have one-year experience in O.T. of
a recognized Hospital?
: YES
Post Qualification Work Experience details as on 30.10.2023 (Start from present
Employer)
Name of the
Employer
Designation Total Period of Service
From To
Nature of Duties Reason of
leaving
Years of
Experience
(YY/MM/DD)
Presently
working?
: YES
SHRI KRISHNA
HOSPI
TAL
OT TECHNICIAN 15/05/2010 30/10/2023 OT TECHNICIAN - 13/5/16
Total Experience in months : 161
Other Details :
Uploaded Document Details :

4. 10/30/23, 7:49 PM RECRUITMENT OF GROUP ‘C’ PARAMEDICAL POSTS
https://ibpsonline.ibps.in/esicjan23/registration_print.php?q=MDQxNzkzOGQzNzE4OTVhZDQyZDc2Njk3MzVhMjNhMTZ8MjU4MTIzMDQw# 4/4
Declaration:
I hereby declare that all the 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 false or incorrect at any stage or not satisfying the eligibility
criteria according to the requirements, my candidature/appointment is liable to be cancelled/terminated.
Date: 30-10-2023
Left Thumb Impression
Hand Written Declaration