APPLICATION FORMAT FOR THE POST OF SUB INSPECTOR (GD)

 

 

STAFF SELECTION COMMISSION

 

 
 

Application Form

Format & Size must be exactly as per printed in advertisement

Name of Examination/ Recruitment

___________________________

Space for Office use only
 

Affix here

CRFS

To be cancelled with post office stamp half on CRFS and half on application
 

Paste your recent passport size Photograph duly attested

 

Keep 5 identical copies for use at further stage of recruitment
 
 

 

 

 

 

 

 

 

 

 

 

 


2. Centre of Examination

 

 

 

 

 

 


1.                 

Sr.No

Numbers/Denomination

Amount

Name of Post Office with Address

1

 

 

 

2.

 

 

 

3.

 

 

 

 

               Total Amount

 

 

 
 
Mode of Payment              4. Details of IPO

                                

CRFS

 

IPO

 

Fees Exempted

 

Other mode will be rejected

 

  

 

5.         Name (As recorded in Matriculation Certificate)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.         Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pin Code

 

 

 

 

 

 

 

 

 

7.         Father’s Name (As recorded in Matriculation Certificate )

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.         Date of birth                        9.   Sex            10. Community/Category     11.  EQ (As on ...)

   D    D    M   M  Y  Y    Y    Y            M       F       GC  SC    ST  OBC OII IIII XS     Graduate P/Graduate

 

 

 

 

 

 

 

 

 
 

 

 

 
 
 

 

 

 


DECLARATION

 

            I hereby certify & declare that (a) I have read the provisions in the rules and the Notice of the examination carefully and I hereby undertake to abide them; (b) All the statements made in the application are true, complete and correct to the best of my knowledge & belief; (c) I fulfil all conditions of eligibility as prescribed in the Notice for admission to the examination; (d) I have not submitted any other application in response to the same Notice/advertisement; (e) I have not been debarred by the commission & have not been convicted by the Court.  In the event of information or part thereof being found false or detected incorrect before or after the examination or at any stage and or that I am not satisfying the eligibility criteria prescribed in the Notice, my candidature/appointment is liable to be cancelled/terminated automatically without any notice to me and actions can be taken against me by the Commission.

 

 

Place                                                                                          Signature of the Applicant

Date                                           ( Application not signed by the candidate will be rejected)

 

 

(Repeat Certification  statement  written  below  in  your  own  handwriting  &  put  Your  Signature)

“ I certify that I am the applicant whose name, date of birth and other particulars are given herein.”

____________________________________________________________________________________________________________________________________________

 

 

Signature of Applicant