Karnataka State Pollution Control Board

Application format for Direct Recruitment

Notification No: ..............................................
Date of Advertisement: ......................... Affix Recent
Name of the Post applied for: Assistant Environmental Officer Passport size
Tick in the appropriate box photograph
M.Sc. B.E./B.Tech/M.E./ here
Candidate M.Tech/P.H.E. Candidate

Name of the Bank D.D. Amount D.D. Number and Date

1. Applicants full Name:

2. Father/Husband Name:
3. Postal/Permanent Address:

4. Date of Birth and Age:

D D M M Y E A R Age
5.
Gender Male Female
6. Nationality:
7. A. Claiming reservations: tick in the appropriate box.
GM SC ST Cat-1 2A 2B 3A 3B Sub Caste

B. Other Reservations: tick in the appropriate box

Kannada Physically Project Ex-
Rural
Medium challenged Displacement Person Serviceman

8. Government employee Yes No

9. Working as Contract employee in KSPCB

Qualification: Yes No
Qualification Total Marks
Semester/Year
(Tick for the appropriate) Marks Obtained Percentage
1st semester/yr
Candidates must have secured First Class in

3. B.E. (Civil) with atleast two elective subjects

pollution control with any basic degree in
1. M.E./M.Tech, PHE Env or industrial

2nd semester/yr
6. M.Sc. (Chemistry/Bio-Chemistry) or

3rd semester
2. B.E. (Civil Env) B.E. (Env) or

4th semester
4. B.E./B.Tech (Chemical)
5. M.Sc. (Env.Science) or

7. M.Sc. (Micro-Biology)

5th semester

6th semester
in Env. Engg. or

7th semester
engg. or

8th semester

Self Declaration: The information provided in the above application is complete and correct. If
found incorrect my application can be rejected and civil/criminal case can be lodged against
me.
Place:
Date: Applicants signature
 Karnataka State Pollution Control Board
Application format for Direct Recruitment
Notification No: ..............................................
Date of Advertisement: ......................... Affix Recent
Name of the Post applied for: Scientific Assistant Passport size
Name of the Bank D.D. Amount D.D. Number and Date photograph
here
1. Applicants full Name:
2. Father/Husband Name:
3. Postal/Permanent Address:

4. Date of Birth and Age:

D D M M Y E A R Age
5.
Gender Male Female
6. Nationality:
7. A. Claiming reservations: tick in the appropriate box.
GM SC ST Cat-1 2A 2B 3A 3B Sub Caste
-- -- --
B. Other Reservations: tick in the appropriate box
Kannada Physically Project Ex-
Rural
Medium challenged Displacement Person Serviceman
--- --- ---

8. Computer Knowledge Yes No

9. Government employee Yes No
10. Working as Contract employee in KSPCB

Qualification: Yes No
Total Marks
Qualification Semester/Year Percentage
Marks Obtained
st
1st yr/
A Degree in Science with 1 ndsemester degree
Chemistry as one of the 2nd yr/
2rd semester degree
optionals 3 yr/
Knowledge in computer 3rd semester degree
operation is essential 4th semester degree
(i.e.DOS, Windows, 5th semester degree
Internet, M.S.Office Etc.)
6th semester degree

Self Declaration: The information provided in the above application is complete and correct. If
found incorrect my application can be rejected and civil/criminal case can be lodged against
me.
Place:
Date: Applicants signature
 Karnataka State Pollution Control Board
Application format for Direct Recruitment
Notification No: ..............................................
Date of Advertisement: ......................... Affix Recent
Name of the Post applied for: Stenographer Passport size
Name of the Bank D.D. Amount D.D. Number and Date photograph
here
1. Applicants full Name:
2. Father/Husband Name:
3. Postal/Permanent Address:

4. Date of Birth and Age:

D D M M Y E A R Age
5.
Gender Male Female
6. Nationality:
7. A. Claiming reservations: tick in the appropriate box.
GM SC ST Cat-1 2A 2B 3A 3B Sub Caste
-- -- -- -- --
B. Other Reservations: tick in the appropriate box
Kannada Physically Project Ex-
Rural
Medium challenged Displacement Person Serviceman
--- --- --- ---

8. Computer Knowledge Yes No

9. Government employee Yes No
10. Working as Contract employee in KSPCB

Qualification: Yes No
Total Marks
Qualification Percentage
Marks Obtained
Pass in SSLC or equivalent SSLC
examination AND Must have
passed senior grade Kannada Shorthand
examination in Kannada senior
and English Shorthand and
Typing examination English Shorthand
conducted by the senior
Karnataka Secondary
Education Examination Kannada Typing
Board. Knowledge in senior
computer operation is
essential (i.e. DOS, English Typing
Windows, Internet, senior
M.S.Office etc.,)

Self Declaration: The information provided in the above application is complete and correct. If
found incorrect my application can be rejected and civil/criminal case can be lodged against
me.
Place:
Date: Applicants signature
 Karnataka State Pollution Control Board
Application format for Direct Recruitment
Notification No: ..............................................
Date of Advertisement: ......................... Affix Recent
Name of the Post applied for: Junior Data Entry Operator Passport size
Name of the Bank D.D. Amount D.D. Number and Date photograph
here
1. Applicants full Name:
2. Father/Husband Name:
3. Postal/Permanent Address:

4. Date of Birth and Age:

D D M M Y E A R Age
5.
Gender Male Female
6. Nationality:
7. A. Claiming reservations: tick in the appropriate box.
GM SC ST Cat-1 2A 2B 3A 3B Sub Caste

B. Other Reservations: tick in the appropriate box

Kannada Physically Project Ex-
Rural
Medium challenged Displacement Person Serviceman
--- ---

8. Computer Knowledge Yes No

9. Government employee Yes No
10. Working as Contract employee in KSPCB

Qualification: Yes No
Total Marks
Qualification Percentage
Marks Obtained
SSLC
A pass in SSLC, Senior
Typing in English & Kannada Kannada Typing
and knowledge of senior
computers. English Typing
senior

Self Declaration: The information provided in the above application is complete and correct. If
found incorrect my application can be rejected and civil/criminal case can be lodged against
me.
Place:
Date: Applicants signature
 Karnataka State Pollution Control Board
Application format for Direct Recruitment
Notification No: ..............................................
Date of Advertisement: ......................... Affix Recent
Name of the Post applied for: Second Divisional Assistant Passport size
Name of the Bank D.D. Amount D.D. Number and Date photograph
here
1. Applicants full Name:
2. Father/Husband Name:
3. Postal/Permanent Address:

4. Date of Birth and Age:

D D M M Y E A R Age
5.
Gender Male Female
6. Nationality:
7. A. Claiming reservations: tick in the appropriate box.
GM SC ST Cat-1 2A 2B 3A 3B Sub Caste
--
B. Other Reservations: tick in the appropriate box
Kannada Physically Project Ex-
Rural
Medium challenged Displacement Person Serviceman

8. Computer Knowledge Yes No

9. Government employee Yes No
10. Working as Contract employee in KSPCB

Qualification: Yes No
Total Marks
Qualification Percentage
Marks Obtained
Pass class in SSLC or
equivalent examination,
knowledge in computer SSLC
operation (i.e. DOS,
Windows, Internet, MS
Office etc)

Self Declaration: The information provided in the above application is complete and correct. If
found incorrect my application can be rejected and civil/criminal case can be lodged against
me.
Place:
Date: Applicants signature
 Karnataka State Pollution Control Board
Application format for Direct Recruitment
Notification No: ..............................................
Date of Advertisement: ......................... Affix Recent
Name of the Post applied for: Field Assistant Passport size
Name of the Bank D.D. Amount D.D. Number and Date photograph
here
1. Applicants full Name:
2. Father/Husband Name:
3. Postal/Permanent Address:

4. Date of Birth and Age:

D D M M Y E A R Age
5.
Gender Male Female
6. Nationality:
7. A. Claiming reservations: tick in the appropriate box.
GM SC ST Cat-1 2A 2B 3A 3B Sub Caste
-- --
B. Other Reservations: tick in the appropriate box
Kannada Physically Project Ex-
Rural
Medium challenged Displacement Person Serviceman
--- --- ---

8. Computer Knowledge Yes No

9. Government employee Yes No
10. Working as Contract employee in KSPCB

Qualification: Yes No
Total Marks
Qualification II year Percentage
Marks Obtained
A pass in PUC with Science
subjects or equivalent PUC with Science
examination, knowledge in subjects
computer operation (i.e.
DOS, Windows, Internet,
M.S.Office Etc.)

Self Declaration: The information provided in the above application is complete and correct. If
found incorrect my application can be rejected and civil/criminal case can be lodged against
me.
Place:
Date: Applicants signature
 Karnataka State Pollution Control Board
Application format for Direct Recruitment
Notification No: ..............................................
Date of Advertisement: ......................... Affix Recent
Name of the Post applied for: Peon/Watchman Passport size
Name of the Bank D.D. Amount D.D. Number and Date photograph
here
1. Applicants full Name:
2. Father/Husband Name:
3. Postal/Permanent Address:

4. Date of Birth and Age:

D D M M Y E A R Age
5.
Gender Male Female
6. Nationality:
7. A. Claiming reservations: tick in the appropriate box.
GM SC ST Cat-1 2A 2B 3A 3B Sub Caste
-- --
B. Other Reservations: tick in the appropriate box
Kannada Physically Project Ex-
Rural
Medium challenged Displacement Person Serviceman
--- --- ---

8. Government employee Yes No

9. Working as Contract employee in KSPCB

Qualification: Yes No
Total Marks
Qualification Percentage
Marks Obtained
Should have passed 7th std.
Examination. Knowledge of 7th Standard
Kannada in writing and Examination
reading is essential

Self Declaration: The information provided in the above application is complete and correct. If
found incorrect my application can be rejected and civil/criminal case can be lodged against
me.
Place:
Date: Applicants signature