STATE LEVEL POLICE RECRUITMENT BOARD, ANDHRA PRADESH.

Online Application from for the posts of SCT PC (Civil) (Men & Women)- Post Code No.21,
SCT PC (AR) (Men & Women)-Post Code No.22, Warder (Male)-Post Code No. 53 and
Warder (Female)-Post Code No. 54, in Prisons and Correctional Services Dept.,-2016,
vide Notification No. 202/R&T/Rect.II/2016, dt:- 22.07.2016.

Stage-II - Online Application Form

I have read the above Notification in detail, understood the same and submitting following
information in compliance to the instructions issued in the above Notification.
34. At the time of submission of Online Application Form, the
age of 18-22 years as on 1st July, 2016. Subsequently, it has been
raised the maximum age limit by (2) years. Earlier you have
submitted Post Preferences as under. Do you want to modify.

O Yes

O No

If Yes, what is your revised Post preferences

1st Preference
2nd Preference
3rd Preference
Drop Down Box
1. Visakhapatnam, 2. Kakinada,
3.Vijayawada, 4. Guntur, 5.
Tirupati, 6. Kurnool

35. Which is your preferred for writing Final

Written Exam
1st Preference
2nd Preference
36. As per information provided by you in Column
No.21, you are local of Andhra Pradesh to
District

Drop Down Box

To justify your claim, furnish information in Study/Residence details as applicable

Study details (Give duration of Study)

Sl. No.

Class

Month & Year

School Name

Name of the District

4th Class
5th Class
6th Class
7th Class
8th Class
9th Class
10th Class
Select District : 1. Srikakulam, 2. Vizianagaram, 3. Visakhapatnam, 4. East Godavari, Kakinada
West Godavari, Eluru, 6. Krishna, Machilipatnam, 7. Guntur, 8. SPS Nellore, 9.Prakasam, Ongole
10. Anantapuramu, 11. Chittoor, 12. Y.S.R. District Kadapa, 13. Kurnool.
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5.

Residence Details
To the Candidates who have not studied in any educational institutions during the whole or part
of the relevant 4/7 years period preceding to SSC/Matriculation or equivalent (Private Study) or
acquired degree from open universities without studying SSC/Matriculation or equivalent in
educational institutions but claim to be local candidate by virtue of residence
Sl. No.

Year
4th Class
5th Class
6th Class
7th Class
8th Class
9th Class
10th Class

Address

Name of the District

Drop Down Box for selecting the

Districts (13 Districts in A.P.)

Age Relaxation
37. As per information provided by you
in Column No. 22 you claimed under
age relaxation an employee of the A.P.
Govt.

O Yes

i) Date of Joining Service

O No

DD/MM/YYYY

ii) Length of Service as on 01.07.2016

iii) Are you still in Service

O Yes

O No

38. As per information provided by you

inColumn No. 33 you claimed agerelaxation under Army, Naval or Air
Force of the Union

O Yes

O No

If yes, furnish the following:

i) Date of Entry in Service

DD/MM/YYYY

ii) Date of Discharge

DD/MM/YYYY

iii) Total Service rendered

39. As per information provided by you
inColumn No. 29 you claimed agerelaxation under an instructor
in NCC.

O Yes

O No

If yes, furnish the following:

i) Date of Entry

DD/MM/YYYY

ii) Date of Discharge

DD/MM/YYYY

iii) Total Service rendered

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40. As per information provided by you

inColumn No. 30 you claimed agerelaxation under employee in the
State CensusDepartment during 1991:

O Yes

a) If yes, Length of Service in Census

Department

O No

Year/Month/Day

41. As per information provided by you

inColumn No. 32 you claimed agerelaxation under Widow, Divorcee/
Judicially separated women:

O Yes

O No

42. As per information provided by you

inColumn No. 23 you claimed agerelaxation under Ex- Servicemen
quota:

O Yes

O No

a) Have you been discharged as on

date of notification (22.07.2016)

O Yes

O No

a) Furnish the following information

i) If widow, furnish the Date of death of
the Spouse
ii) If divorced women or judicially
separated from your husband,inform
the date of divorce or date of Judicial
Separation

I) If yes, furnish the following:

i) Date of entry

DD/MM/YYYY

ii) Date of discharge

DD/MM/YYYY

iii) Total Service rendered:

II) If No, furnish the following:
i) Date of entry :
ii) Likely date of discharge :
iii) Total Service rendered:
43. Your preference for post code-21 in this Application
Go through the notification before
selecting the posts
1st Preference
2nd Preference
3rd Preference
4th Preference
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5th Preference
6th Preference
7th Preference
8th Preference
9th Preference
10th Preference
11th Preference
12 th Preference
13 th Preference
14 th Preference
15 th Preference
16th Preference
17th Preference
18th Preference
44. Your preference for post code-22 in this Application
Go through the notification before
selecting the posts
1st Preference
2nd Preference
3rd Preference
4th Preference
5th Preference
6th Preference
7th Preference
8th Preference
9th Preference
10th Preference
11th Preference
12 th Preference
13 th Preference
14 th Preference
15 th Preference
16th Preference
17th Preference
18th Preference

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45. As per information provided by you

inColumn No. 26 you claim benefit of
Special Reservation for the post code
21 & 22 under following categories

O NCC

O CPP

O CDI

O MSP

O HG

I) Furnish the details if you claim reservation under the Meritorious Sports Men quota?
(Should satisfy the conditions as given in para 16 (b) (iii) of the Notification)
Name of the Sport/ Game

Category-1/Category-2/Category-3

II) Furnish the details if you claim reservation under NCC ( NCC-A, NCC-B, NCC-C)quota
Certificate

Date on which the candidate was obtained

III. Furnish details of your parent if you claim reservation under Children of Police Personnel (CPP)
i) Date of enrollment of your parent
ii) Name of the Post
iii) Name of the Unit
iv) Is your parent 'working' or 'died'as
on 22.07.2016

O Working

O Retired

O Died

IV. For Children of Deceased & Incapacitated (CDI) due to violent action of extremists/Criminals/
Anti- Social elements & retired on medical invalidation while on duty only.
Furnish details of your parent if you claim reservation under CDI quota
i) Date of enrollment of your parent
ii) Name of the Post
iii) Name of the Unit
iv) Is your parent died (or) retired on
medical invalidation as on 22.07.2016

O Died

O Retired on Medical invalidation

V) Furnish details if you claim age relaxation and/ or reservation under Home Guard Quota (HG)
i) Name of the Unit
ii) Date of enrollment
iii) No.of years since enrollment
iv) No. of days worked as Home Guard
between 23.07.2014 to 22.07.2016
v) Are you still working as Home Guard
as on 22.07.2016

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46. As per information provided by you in Column No. 27 you claim benefit reservation under CJP
quota (Children of Jail/Prison Personnel) for post code no. 53.
i) Date of enrollment of your parent
ii) Name of the Post
iii) Name of the Unit
iv) Is your parent working (or) retired
(or) dead as on 22.07.2016

O Working

O Retired

O Dead

Other Details
47. As per the Rule 3 (G) of A.P. (SCT) Rules, 1999,
involment in a Criminal case involving moral turpitude
(OR) conviction for any offence in any court of law,
is a bar for an employment.
. Were you involved in any Criminal Case (s)
at any time?

O Yes

O No

48. Were you ever arrested by the Police

O Yes

O No

49. If you were prosecuted by the Police

in a Court of Law.
Furnish the present stage of the case

Drop Down Box

Crime No. & Year

Name of the Police Station
Name of the District

Under Investigation/ Pending Trail/

Discharge/Compound/Acquitted/
Convicted/Mistake of fact
50. Were you involved in more than one
Criminal case

O Yes

O No

O Yes

O No

51. Total No. of Criminal cases involved

52. Were you at any time employed and discharged
/ terminated/removed/dismissed from service
of the Government (whether during training or
later)?
Name of the Post
Name of the Department
Date of Discharge / Terminated/ Removal
/Dismissal

DD/MM/YYYY

Office Address

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53. The following relevant documents will be submitted by me when I appear for PMT/PET.
I understood the insturctions given in Notification
a) Secondary School/Matriculation certificate or equivalent certificate in support of the date of birth.
b) Educational qualification Intermediate or its equivalent examination certificate. For those SC/ST
candidates who have not passed the Intermediate or its equivalent examination but passed SSC or its
equivalent examination and studied Intermediate and appeared for the Intermediate Examination of
1st year and 2nd year must submit the Memorandum of Marks of both the 1st and 2nd year
c) BC candidates who wish to claim concession in age and also reservation specified for the Backward
Classes should submit the LATEST Community & Date of Birth Certificate and Certificate of their
exclusion from the Creamy Layer issued by the competent revenue authority as specified under.
d) The SC/ST candidates who wish to claim concession in age and also reservation specified for the
SC/ST, should submit the LATEST Community & Date of Birth Certificate issued by the competent
authority as specified above.
e) Certificate from the competent authority in respect of State Government employees/those who
worked in the Army, Navy or Air Force of the Indian Union/NCC Instructors/ retrenched
temporary employees in the State Census Department during 1991 for claiming age concession.
f) Residence certificate in the agency area from the competent authority in respect of candidates
belonging to Scheduled tribes and Aboriginal Tribes in the agency areas who claim relaxation in
Physical Measurements or reservation.
g) Study certificate issued by the School authorities or Residence certificate (in case the candidate not
studied in any Educational Institution preceding to SSC/Matriculation or equivalent (Private study)
issued by Tahasildar of the concerned Mandal, for determining local status.
h) Home Guards Service Certificate/Certificate of CPP/Certificate of CDI/Certificate of CJP issued
after the date of notification, wherever applicable.
i) Ex-servicemen certificate/Meritorious Sports persons Certificate/NCC A,B,C certificate etc.,
wherever applicable.
j) The candidate who migrate from Telangana State to Andhra Pradesh State should submit a Local Status
Certificate issued by MRO as per the Proforma issued by Govt.,of Andhra Pradesh, vide Circular Memo No.
4136/SPF & MC/2015-5, dt: 08.08.2016, for consideration of his candidature for Local to that District.

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