No.

( For official use )

STATE SELECTION BOARD, ODISHA POLICE,

CUTTACK

One Passport size

colour Photograph
of the candidate
with self
attestation
should be pasted

APPLICATION FORM FOR APPOINTMENT OF CONSTABLE

IN ODISHA INDUSTRIAL SECURITY FORCE(OISF).
( Candidate should fill-up of the application form after
thorough going of the advertisement).
1. Name of the Candidate

2. Fathers / Husbands Name

3. Present Address (for correspondence):

4. Permanent Address

5. Contact
(a) Telephone
(b) Mobile
(c) E-mail

:
:
:
:

6. Date of Birth
(As per HSC Certificate)

7. Age as on 01.01.2015

: Year ______ Month _______ Day _______

8. Sex

9. Religion

10. Nationality

11. Category
:
(The candidate should enclose
Photo copy of Caste Certificate in their
respective category with self attestation)

Male

Female

SC

ST

SEBC

UR

12. Educational Qualification upto HSC :

Examination.
(Photo copy of certificate along with
HSC Mark sheets should be enclosed
with Self attestation)
Name of
Year of Name of the Board/
the
passing Council
Examination
passed
( HSC &
equivalent)

Division

13. Has the Candidate passed Odia as one

:
of the subject in HSC Examination or an
examination in Odia language equivalent
to M.E. Standard recognised or conducted by
the School and Mass Education Department
of Odisha. (photo copy with self attestation
should be enclosed )
14. Are the Candidate Ex-Serviceman /
:
Sports person / Home Guard
If Yes the Reservation in which
category please indicate in appropriate box.
15. (A) whether the candidate is married
(B) If married, whether he/she has more than:
one spouse living?
16. Registration No., Date and
Name of Employment Exchange.

Total
No.

Mark
secured

Yes

HG

ExArmy

Percentage
of Marks
secured

No

Sports
person

:
Yes

No

Yes

No

17. Mode of payment of Application Form

:
with the details of Amount, No. and Date.
and copy of receipt to be attached.
18.

Mode of payment of Examination Fees

with details of Amount, No. and Date.
(Not applicable for SC/ST Candidates)

19. whether the candidate is a Sports Person ?

Yes
:

No

3
If Sports Person (candidate only indicate
one sports event participated in
Open National Championship / International
Championship and the same should be
recognised and sponsored either by the
recognised National Sports Federations /
Associations or Indian Olympic Association,
Odisha State Sports Association, Affiliated to
the recognised National Sports Federation /
Association).
(A) Participated in Sports Event

(B) In which Sports and Category

(National / International)

(C) Awarded any Medal (Gold/Silver/Bronze):

Appreciation ( 1st / 2nd / 3rd )
20.

21.

Whether the candidate possess NCC Certificate ?:

If possess NCC Certificate

Yes

Category of NCC Certificate

Whether the candidate possess a :

Driving licenses having the validity
for at least 1 year (Excluding the
learning period) ?
(A) Licenses No. and Date.

No
B

Yes

C
No

(B) Name of the RTO Office from which :

license issued.
(C)

22.

Whether the license is applicable for Heavy :

Vehicle or light vehicle (photo copy of
such license with self attestation
should be enclosed).

Whether the candidate involved in any criminal :

case?
( If yes, the details of the criminal case and/
or the details arrest be provided.

Yes

No

4
23.

Check list.

(1)

Self attested photo copy of HSC Certificate.

(2)

Self attested photo copy of HSC Mark Sheets.

(3)

Application Fees Rs.150/- in shape of Bank Draft /

Postal Order (Original) (Not applicable for SC/ST
Candidate).

(4)

Application Form Rs.35/- in shape of Bank Draft /

Postal Order (Original) and its receipt.

(5)

Self attested photo copy of Caste Certificate.

( for SC / ST / SEBC Category ).

(6)

Self attested photo copy of Employment Exchange

Certificate.

(7)

Passport Colour Photographs - 3 nos.

( self attestation)

(8)

Other documents, if any.

DECLARATION
I, Shri / Kumari / Smt.
Father / husband ..
declared that the above statement furnished is completely correct to the best of my
knowledge. If any, facts stated above are found to be in-correct my candidature will
stand cancel.
I agree to serve any where in Odisha if selected as a Constable in Odisha
Industrial Security Force(OISF).
Place :
Date :

Full Signature of the Candidate

5
Declaration for participation in Physical Efficiency Test
for appointment as Constable in Odisha Industrial Security Force
(OISF) .
I undersigned Shri / Kumari / Smt.
Father / Husband ..
Village Post ..
P.S. .. Dist ..
I hereby declared that I am completely capable and fit to appear in the Physical
Efficiency Test for the post of Constable in OISF. During the Physical Efficiency Test if
any, Physical injury or untoward accident takes place, the concerned officers shall not
be held responsible or liable.

Place :
Date :

Full Signature of the Candidate