Annexue-1

Check List for documents verification

Name: Post:

All the successful candidates shall bring a set of self attested copies of the documents as
mentioned below at the time of reporting their joining at designated training centre
alongwith the original documents for verification:
(ORIGINALS SHALL BE RETURNED)
1 Aadhar Card YES NO
2 PAN Card YES NO
3 Personal Bank Account Passbook YES NO
4 Proof of Date of birth YES NO
5 5(five) nos. of recent Passport size coloured photograph YES NO
(3cmx4cm) with white background
6 Proof of Education Qualification YES NO
7 Original Admit Card of recruitment (Written and YES NO

Interview):
8 Certificate of Caste ( as applicable) YES NO
9 Latest EWS Certificate (if applied under EWS quota) YES NO
10 Non creamy layer certificate (if applicable) YES NO
11 PWBD Certificate (if applied under PWBD quota) YES NO
12 Ex-Serviceman Certificate (if applied under Ex- YES NO
Serviceman quota)

(ORIGINALS SHALL BE RETAINED)

1. Notarized Affidavit

2. Undertaking / Affidavit

3. Employee Personal Data Sheet

4. Uniform Measurement Details

5. Medical Fitness Certificate

Signature of the candidate

Name & Post:

O.O. No. & Date:

Mobile No:
 Annexure-2

AFFIDAVIT

I……………..……………………. son/daughter/wife of …….aged……..years, resident of ……………

(Mention full postal address), do hereby declare the followings to facilitate my appointment to the below
mentioned post, without Police Verification Report:-

1. That I am citizen of India by……....and a resident of the aforesaid locality.

2. That I am a selected candidate for the post of …………….. which was advertised vide
no………………………………….and the final selection list of which was published/intimated vide
no………….……………………………………………… Dated…………..
3. That contact telephone number(s) is/are……. and my e-mail id (if any) is………………
4. That, I hereby declare that there is no pending criminal case against me.
5. That, I have not been convicted of any offence involving moral turpitude and have not been dismissed
from service by the Union Government or by a State Government or any Local/ Autonomous Body.
6. That, I am not a member of or associated with any body or association declared unlawful.
7. That, there is nothing in my character and antecedents which renders me unsuitable for appointment to
the above-mentioned post.
8. That, if anything is found contrary to the declarations made herein above in this affidavit, and if the
Appointing Authority is satisfied that such finding renders me unsuitable for the service, may
discharge/remove or dismiss me from the Service without assigning any reason or divulging the
findings. In such an event, I will have no claim or grievance against the appointing
authority/authorities and I shall be liable to be prosecuted under the Law.
9. That, the statements made in paragraphs 1 to 8 above are true and correct to the best of my knowledge
and belief and no part of it is false and nothing material has been concealed therefrom.
And I sign this affidavit today on …………......20…………...….at…………….…

Identified by me

Advocate,……..

DEPONENT

Solemnly affirmed and declared before me by the

deponent who is identified by………………….....

Advocate,…..on this…...day of ….., 20…..at…….

 Annexure-3

UNDERTAKING

"I,…………………………………………………………………..…..(Name), appointed

as…………......................................(Designation) in Forest Department, Government of

Assam do hereby solemnly affirm and declare that, I voluntarily and without duress agree

to the terms and conditions mentioned in the appointment order. I also solemnly affirm

and declare that I satisfy all the qualifying criteria of the post to which I am appointed to. I

also declare that I do not have more than one wife living (applicable for male candidates) /

have married a person who has wife living (applicable for female candidates). I also further

declare that I do not have more than two living children on or after 01-01-2021 from a

single or multiple partners. In case of any detection to the contrary in due course, I shall be

summarily discharged from the Service"

( )

Signature

Name & Post:……….................................................

Office Order No. …………….…….Date:…………..

Mobile No:……………………………………………..
 Annexure-4

Employee Personal Data Sheet

Name of Department: Forest Department, Assam

Employee Personal Information

1. First Name:
Photo

2. Middle Name:

3. Last Name:

4. Date of Birth:

5. Father/Mother/Husband Name: _

6. Gender: Male/Female: 7. Marital Status:

8. Identification Mark:

9. Aadhar Number :

10. Temporary address:

P.S. P.O. Vill/City

District PIN

11. Permanent address:

P.S. P.O. Vill/City

District PIN

12. Blood Group:

13. Height in cms :

14. Caste: [General/OBC/MOBC/SC/ST(P)/ST(H)]

15. Whether belongs to EWS/PWBD/Ex-Serviceman

16. Mobile NO:

17. Email-ID:

18. PAN No:

Signature of the candidate

 Name of Candidate:

19. Personal Bank Account details:

Bank Name Branch address Account Number IFSC Code

20. Educational Qualification :

Percentage
Sl. Year of
Class University/College/School Subject of marks
No. Passing
obtained

21. Special Skill ( Computer / GIS):

22. Sports ( District/State/National/International)
23: Any other special Skill (including art & culture):
24. Awards received:
25. Emergency Contact Name with mobile no.:

Signature of the candidate

Name & Post:

O.O. No. with Date:

Mobile No:
 Annexure-5

Uniform Measurement Details

Photo

1. Name of the candidate :

2. Gender :
3. Place of initial Posting :
4. Appointment Order No. :

Length in inch
Chest in inch
Shirt measurement
Sleeve length in inch
Shoulder in inch
Length in inch
Hips in inch
Trousers Waist in inch
Inside length in inch
Bottom in inch
Shoes Size
Woollen Jersey S/M/L

Signature of the candidate

Mobile No……………………………………….
 Annexure-6

Medical Fitness Certificate

[To be obtained from the District/ Sub-Divisional level Civil Hospital/Medical

College of the Govt of Assam]

This is to certify that the undersigned has medically examined Shri/Smt

_____________________________________________ (Name), Son/Daughter of

_______________________________________ having been appointed to the post of

____________________________________________________ of the Forest

Department, Govt of Assam and found that he/she is in good mental and bodily health

and is free from any physical defect likely to interfere with the efficient performance

of his/her duties.

Sign and seal of Doctor:

Name of Doctor:

Date:

With Stamp and Seal:

 Annexure-7

JOINING LETTER

(To be signed only after document verification at the Reporting centre)

Dated ……………………

To

The Reporting Centre Incharge

………………………………………………

……………………………………………..

Sub: - Joining for the post of in the Assam Forest

Department .

Ref:- PCCF & HoFF, Assam Office Order No………dated……………………………

Sir,
In pursuance of the PCCF & HoFF, Assam Office Order No…………….
dated ………………….., I hereby report my joining as ………………………….. at
………………………………………… for undergoing Orientation/Induction training in the
Forenoon/Afternoon of …………………………….. June, 2023.
I understand and accept the Terms & Conditions of the employment that has been
mentioned in the appointment order.
I also hereby submit the self attested copies of relevant documents (as per the
signed checklist enclosed) along with undertaking and notarized affidavit in original.
This is for favour of your kind information and necessary action.

Encls.: As stated
Yours faithfully,

( )

Signature

Name & Post:……….................................................

Initial Place of posting…………………………………

Mobile No:……………………………………………..

Copy to : Officer concerned as per initial place of posting.