Application Form and Admit Card

APPLICATION FORM\n(To be neatly typed on A4 size paper)\n\nAdvertisement No. : CBC 10103 / 11 / 0004 / 2526\n\nApplicants are required to affix a Recent Passport size photograph.\n\n#### Applicant Details (To be filled by candidate)\n\n1. Post Applied For: Specify Unit.\n2. Name of the Candidate: In Capital Letters.\n3. Personal Information:\n * (a) Father's/Husband's Name\n * (b) Mother's Name\n * Date of Birth: DD/MM/YYYY\n * Age: As on last date of receipt of application (Years, Months, Days)\n * Gender\n * Nationality\n * Religion\n4. Correspondence Address:\n * Pin Code\n * State\n * Contact / Mobile No\n * Email ID\n5. Permanent Home Address:\n * Pin Code\n * State\n * Contact / Mobile No\n * Email ID\n6. Category: UR / SC / ST / OBC / EWS (UR) / ESM. Please enclose photocopy of relevant certificate.\n * Abbreviations used for Category:\n * UR: Un-reserved\n * SC: Schedule Caste\n * ST: Schedule Tribe\n * OBC: Other Backward Class\n * EWS: Economically Weaker Section\n * PwBD: Person with Benchmark Disability\n * ESM: Ex-Serviceman\n7. Physically Handicapped Category (If applicable):\n * Type of disability: B, LV, D, HH, OA, OL, OAL, CP, LC, DW, AAV, ASD (M, MoD), SLD (M), MI(M), MD\n * Percentage of disability: 40 % and above.\n * Enclose photocopy of disability certificate issued by CMO/Civil Surgeon of Government hospital certifying the disability duly self attested.\n * Abbreviations used for Disability Types:\n * B: Blindness\n * LV: Low Vision\n * D: Deaf\n * HH: Hard of Hearing\n * OL: One leg\n * OA: One Arm\n * OAL: One Arm and One Leg\n * CP: Cerebral Palsy\n * Dw: Dwarfism\n * AAV: Acid Attack Victim\n * LC: Leprosy Cured\n * ASD(M, MoD): Autism Spectrum Disorder (M-Mild, MoD- Moderate)\n * SLD(M): Specific Learning Disability (M-Mild)\n * MI(M): Mental Illness (Mild)\n * MD: Multiple Disability\n8. Length of Combatant Service (applicable for ESM only):\n * Years, Months, Days.\n * Date of enrolment: In Army/Navy/Air Force.\n * Date of retirement.\n * Enclose photocopy of discharge certificate.\n9. Details of Age Relaxation Required: Applicable as per Central Government Policy.\n10. Qualifications:\n * (i) Educational:\n * Name of examination, Year, Board/University/Institution, Percentage of marks obtained, Grade/Division.\n * Enclose photocopy of educational/qualification certificate.\n * (ii) Experience:\n * Organization, Whether Govt/PSU/Private, Post/Appointment, From, To.\n * Enclose photocopy of experience certificate.\n11. List of Enclosures:\n * (a) - (e) list of documents.\n12. Details of Identity Proof (Enclose copy):\n * Aadhar Card No\n * PAN Card No\n * Driving Licence No\n * Passport No\n\n### DECLARATION\nI hereby certify that above particulars mentioned in the application are correct and true to the best of my knowledge and belief. There is no criminal proceeding pending/contemplated/held against me. I understand that in the event of my information being found false or incorrect at any stage or not satisfying the eligibility criteria according to the advertisement, my candidature/appointment is liable to be cancelled/terminated. I am willing to serve anywhere in India. I agree that Department has the right to transfer me anywhere in India.\n\nPlace:\nDate:\n**(Signature of the applicant)\n\n### Important Notes for Candidate Enclosures:\n* (i) One self-addressed envelope duly affixed with Rs 5/- postal stamp.\n* (ii) Self-attested photocopies of certificates (____) sheets.\n* (iii) Two self-attested Photographs (Name and Mother's/Father's name on the back side of photo).\n* (iv) Acknowledgement/Admit card.\n\n### ACKNOWLEDGEMENT / ADMIT CARD\n(To be neatly typed on A4 size paper)\n\nApplicants are required to affix a Recent Passport size photograph.\n\n#### Applicant Details (To be filled by candidate)\n\n1. Post Applied For\n2. Unit Applied For\n3. Name of Candidate: In Capital Letters\n4. Date of Birth\n5. Gender\n6. Mother's Name\n7. Father's/Husband's Name\n8. Category Applied For\n9. Correspondence Address:\n * House No./Street/Village\n * Post Office\n * Tehsil\n * District\n * State\n * Pin Code\n10. Tele/Mob No\n * E Mail ID\n\n#### FOR OFFICE USE ONLY\n\nYour application is hereby accepted.\n\n11. Index No\n12. Place\n\n* Bio-metric and Document verification:\n * (a) ________\n * (b) Reporting Time ________\n* Written test:\n * (a) Date ________\n * (b) Reporting Time ________\n\nDate**: ________\n**(Signature of controlling officer)**\n\n### Important Instructions for Candidates:\n\n* (i) Candidates must produce original documents/certificates (i.e., Educational, Caste, Domicile, Birth, Discharge certificate/NOC, and Physically Handicapped certificate) at the time of reporting for document verification. Only after verification of original documents and Biometric Attendance, candidates will be allowed to appear for the written test. The safe custody of the documents is the responsibility of the individual.\n* (ii) Candidates should reach at least one hour before the scheduled time at the examination centre on the aforementioned date. No candidate will be allowed for examination after the scheduled time.\n* (iii) Candidates should bring their pen, pencil, and clipboard for the Written Examination. Candidates must also carry any two proofs of identity (Aadhar Card/PAN card/Passport/Driving Licence).\n* (iv) Mobile phones, calculators, electronic items, paper, and other materials are not allowed. If found with any such item, candidature will be rejected automatically.