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    Application Form Draft Print For All

    Uploaded by

    Harsh Kardam
    The document contains an application received by the Staff Selection Commission for the Constable (GD) in Central Armed Police Forces (CAPFs), SSF, Rifleman (GD) in Assam Rifles and Sepoy in Narcotics Control Bureau Examination, 2022. It includes personal details of the applicant such as name, father's name, date of birth, gender, category, education details, preference of examination centers, address details, photograph details, and declaration signed by the applicant. The applicant is seeking age relaxation under SC/ST category and has passed 10th standard in 2015 from Uttar Pradesh board with 66% marks.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Application Form Draft Print For All

    Uploaded by

    Harsh Kardam
    27 views3 pages
    The document contains an application received by the Staff Selection Commission for the Constable (GD) in Central Armed Police Forces (CAPFs), SSF, Rifleman (GD) in Assam Rifles and Sepoy in Narcotics Control Bureau Examination, 2022. It includes personal details of the applicant such as name, father's name, date of birth, gender, category, education details, preference of examination centers, address details, photograph details, and declaration signed by the applicant. The applicant is seeking age relaxation under SC/ST category and has passed 10th standard in 2015 from Uttar Pradesh board with 66% marks.

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    Nfhchc hmm

    Original Title

    ApplicationFormDraftPrintForAll (1) (2) (1)

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    The document contains an application received by the Staff Selection Commission for the Constable (GD) in Central Armed Police Forces (CAPFs), SSF, Rifleman (GD) in Assam Rifles and Sepoy in Narcotics Control Bureau Examination, 2022. It includes personal details of the applicant such as name, father's name, date of birth, gender, category, education details, preference of examination centers, address details, photograph details, and declaration signed by the applicant. The applicant is seeking age relaxation under SC/ST category and has passed 10th standard in 2015 from Uttar Pradesh board with 66% marks.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    27 views3 pages

    Application Form Draft Print For All

    Uploaded by

    Harsh Kardam
    The document contains an application received by the Staff Selection Commission for the Constable (GD) in Central Armed Police Forces (CAPFs), SSF, Rifleman (GD) in Assam Rifles and Sepoy in Narcotics Control Bureau Examination, 2022. It includes personal details of the applicant such as name, father's name, date of birth, gender, category, education details, preference of examination centers, address details, photograph details, and declaration signed by the applicant. The applicant is seeking age relaxation under SC/ST category and has passed 10th standard in 2015 from Uttar Pradesh board with 66% marks.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    STAFF SELECTION COMMISSION

    BLOCK NO. 12, CGO COMPLEX, LODHI ROAD, NEW DELHI


    110003
    CONSTABLES (GD) IN CENTRAL ARMED POLICE FORCES
    (CAPFs), SSF, RIFLEMAN (GD) IN ASSAM RIFLES AND
    SEPOY IN NARCOTICS CONTROL BUREAU EXAMINATION,
    2022
    REGISTRATION NO: 30005653473

    APPLICATION RECEIVED (CONTENTS NOT VERIFIED)

    1. NAME AS PER MATRICULATION 2. NEW/CHANGED


    3. FATHER'S NAME 4. MOTHER'S NAME
    CERTIFICATE NAME
    HARSH KUMAR - RAKESH KUMAR GEETA DEVI
    5. DATE OF BIRTH (DD/MM/YYYY) 6. AGE AS ON 01/01/2023 7. GENDER 8. CATEGORY
    15/04/1999 23.8 MALE SC
    9. NATIONALITY 10. MARK OF VISIBLE IDENTIFICATION
    CITIZEN OF INDIA CUT ON UPPER LIPS
    12. MATRICULATION (10th 13. MATRICULATION (10th
    11. MATRICULATION (10th CLASS) EXAMINATION BOARD
    CLASS) ROLL NO CLASS) YEAR OF PASSING
    BOARD OF HIGH SCHOOL AND INTERMEDIATE EDUCATION
    0035960 2015
    UTTAR PRADESH
    14.1. WHETHER YOU ARE AN EX-SERVICEMAN (ESM) OR
    14.2. DATE OF JOINING THE ARMED FORCES (DD/MM/YYYY)
    SERVING IN THE ARMED FORCES?
    NO -
    14.3. DATE OF DISCHARGE FROM ARMED FORCES
    14.4. LENGTH OF SERVICE IN ARMED FORCES
    (DD/MM/YYYY)
    - -
    14.5. HAVE YOU ALREADY JOINED A CIVIL POST BY
    14.6. DATE OF JOINING TO CIVIL POST (DD/MM/YYYY)
    AVAILING BENEFIT OF RESERVATION FOR EX-SERVICEMAN (E
    - -
    15.1. WHETHER SEEKING AGE RELAXATION? 15.2 IF YES, AGE RELAXATION CODE
    YES 01-SC/ST
    16.1. ARE YOU A NATIONAL CADET CORPS (NCC)
    16.2. TYPE OF THE NCC CERTIFICATE
    CERTIFICATE HOLDER
    NO -
    17. PREFERENCE OF EXAMINATION CENTRES

    EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER


    ( FIRST PREFERENCE ) ( SECOND PREFERENCE) ( THIRD PREFERENCE)

    AGRA ( 3001 ) KANPUR ( 3009 ) LUCKNOW ( 3010 )

    18. STATE/ UT OF DOMICILE 19. DISTRICT OF DOMICILE

    UTTAR PRADESH AGRA


    20.1. HAVE YOU MIGRATED FROM THE STATE/ UT OF 20.2. WHETHER YOU WOULD LIKE TO AVAIL THE BENEFIT OF
    YOUR ORIGIN TO ANOTHER STATE/ UT RESERVATION FROM THE STATE/ UT OF YOUR ORIGIN
    NO -
    20.3. STATE/ UT OF ORIGIN 20.4. DISTRICT OF ORIGIN
    - -
    21. CANDIDATE BELONGS TO MILITANCY/ NAXAL
    22. CANDIDATE BELONGS TO BORDER DISTRICT
    AFFECTED DISTRICT
    NO NO
    23. PREFERENCE OF POST FOR CAPF(S)/ ORGANIZATION(S)
    B,C,D,G,H,E,F,A
    24. HIGHEST EDUCATIONAL QUALIFICATION
    INTERMEDIATE/ HIGHER SECONDARY/ 10+2 (2)
    25. DETAILS OF QUALIFYING EDUCATION
    10TH STANDARD
    STATUS PASSING STATE/ UT OF BOARD/ NAME OF BOARD/ ROLL NO PERCENTAGE CGPA
    YEAR UNIVERSITY UNIVERSITY
    PASSED 2015 UTTAR PRADESH BOARD OF HIGH 0035960 66 -
    SCHOOL AND
    INTERMEDIATE
    EDUCATION UTTAR
    PRADESH
    26. DO YOU WANT TO MAKE AVAILABLE YOUR PERSONAL INFORMATION FOR ACCESSING JOB OPPORTUNITY IN TERMS OF
    DoP&T'S O.M NO.39020/1/2016-ESTT.(B) DATED 21.06.2016 ?
    NO
    ADDRESS DETAIL
    27. CORRESPONDENCE ADDRESS 28. PERMANENT ADDRESS
    NAI ABADI AJIJPUR AGRA NAI ABADI AJIJPUR AGRA
    DISTRICT: AGRA DISTRICT: AGRA
    STATE: UTTAR PRADESH STATE: UTTAR PRADESH
    PIN: 282001 PIN: 282001
    MOBILE NO. : 7217288626 EMAIL ID: [email protected]
    26. WHETHER PHOTOGRAPH HAS BEEN TAKEN ON OR AFTER 27-JULY-2022?
    YES
    FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE

    EXEMPTED - - -
    DECLARATION
    1. I HAVE READ THE NOTICE OF THE EXAMINATION AND ACCEPT ALL THE TERMS & CONDITIONS OF THE NOTICE
    OF THE EXAMINATION.

    2. I HEREBY DECLARE THAT ALL 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 SUPPRESSED/FALSE OR INCORRECT OR INELIGIBILITY BEING DETECTED BEFORE OR AFTER THE
    EXAMINATION, MY CANDIDATURE/ APPOINTMENT IS LIABLE TO BE CANCELLED.I AM WILLING TO SERVE
    ANYWHERE IN INDIA.

    3. I DECLARE THAT THE PHOTOGRAPH UPLOADED IN THE APPLICATION FORM HAS BEEN TAKEN ON OR AFTER
    THE STIPULATED DATED.

    4. I AGREE TO AUTHORIZE SSC TO USE MY AADHAR DATA FOR VERIFICATION PURPOSE.


    PRINT TAKEN ON: 13/11/2022 10:06:09 PM IP ADDRESS: 106.76.238.179

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