GOVT.

OF INDIA MINISTRY OF HOME AFFAIRS SASHASTRA SEEMA BAL SPECIAL RECRUITMENT DRIVE FOR CONSTABLE (GD) (MALE ) IN JAMMU & KASHMIR STATE
Sashastra Seema Bal will conduct special recruitment drive through local rally to fill up backlog vacancies of Constable (GD) 2011-12 (Male) belonging to Jammu And Kashmir State only. 1. Vacancies:State Code 15 Name of State Jammu & Kashmir (J&K) SC 33 ST 33 OBC 89 GEN 142 Total 297

Note:- 10 % vacancies reserved for Ex-servicemen of J & K State

(i) The vacancies meant for Ex-Servicemen may later be filled up by fresh candidates, if suitable Ex-Servicemen do not turn-up. ii) Number of vacancies are subject to change without any notice. ii) The posts are temporary but likely to be permanent. iii) The recruitment will be conducted only for male candidates belonging to J&K state. iv) Selected candidates are liable to be posted any where within as well as outside the Territory of India according to deployment/transfer policy of the force. 2. Pay Scale:- ( Pay Band 1) : Rs.5,200 - 20,200 + Grade Pay Rs.2,000/- per month. 3. Other Allowances:i) The post will carry Dearness Allowance, Ration Money, Washing Allowance, Free Uniform, Free accommodation or HRA, Transport Allowance, Free Leave Pass and other allowance as admissible in the force from time to time under the Rules/Instructions. ii) The post will be covered under new restructured Contributory Pension Scheme. 4. Eligibility Criteria:(A) Age Limit:i) 18 to 23 years ( Cut off date for age will be 1st August, 2012). ii) The candidate must fulfill all eligibility conditions on 10/04/2012 i.e. the date of commencement of recruitment. However, the crucial date to determine age will be 01/08/2012. (B) RELAXATION IN AGE: i) Upper age limit is relaxable for SC/ST by 5 years and 3 years for OBC.

ii) The upper age limit upto 5 years in case the candidate is already in Govt. service. Government employees/servants claiming age relaxation should be in possession of a certificate in prescribed format from their office in respect of the length of continuous service which should not be less than 03 years in the immediate period preceding the date of commencement of recruitment i.e. 10/04/2012.They should also continue to have the status of Government servant/employees till the time of appointment, in the event of their selection. The candidate will have to produce NOC from his department at the time of appearing for the recruitment. However, departmental candidate may forward their application through proper channel routed through their head of office.

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iii) The relaxation in upper age limit of 5 years shall also be admissible to the candidates who had ordinarily been domiciled in the state of J&K during the period from 01.01.1980 to 31.12.1989. The candidates will have to produce a certificate from the concerned district collector to claim relaxation in age. iv) Five years of age relaxation will also be granted to the children and dependent family members of those killed in the riots (1984 riots and 2002 communal riots of Gujarat). Children means (a) son (including adopted son); or Dependent family members mean: (a) spouse: or (b) children: or(c) brother in case of unmarried Govt. servant who was wholly dependent on the Govt. Servant at the time of his killing in the riots. Children and dependent family members of those killed in the riots (1984 riots and 2002 communal riots of Gujarat) will produce a certificate from the concerned District Collector. v) The above relaxation in age as mentioned in para 2(B) (ii) to (iv) is in addition to relaxation of five years in age for SC/ST and 03 years for OBC candidates as per Govt. orders. NOTE: Candidates claiming benefits under OBC category shall furnish certificate from prescribed authority mentioning gazette notification of belonging to castes notified in the Central list. The certificate should be in the prescribed format issued by the competent authority empowered for the purpose. No other certificate will be accepted as proof. (C) Educational qualification:- Matriculation or 10th Pass from a recognized board/university.as on the date of commencement of recruitment i.e.10.4.2012. Note:- (i) Educational certificates other than State board/ Central board should be accompanied with Govt. of India notification declaring that such qualification is equivalent to Matriculation/10th Class pass for service under Central Government. D) Physical Standard:Height Sl. State No. 1. For all categories 165 Cms. & except those given above. at Sl.no. 2 below 2. For the candidates 162.5 Cms. belonging to Scheduled Tribe of J&K State. (E) Medical Standard:i) Eye Sight: - The minimum distant vision should be 6/6 and 6/9 without correction i.e. without wearing of glasses. They should possess high colour vision and should be free from colour and night blindness. ii) The Candidates must not have knock-knee, flat foot, varicose vein or squint in eyes. They must be in good mental and bodily health and free from any physical defect likely to interfere with the efficient performance of the duties. They should conform to the medical standards prescribed by the Force and should be declared fit by board of Medical Officers of SSB. The opinion of the Board of Medical Officers of SSB shall be final and no appeal shall lie against it. 5. Conditions for Ex-Servicemen:For recruitment of Ex-Servicemen following will be the criteria:i) Physical standard : Total relaxation ii) Medical category : Category SHAPE-I iii) Character: Exemplary/Very Good/Good iv) Break in service: Not more than 24 months as on 01/08/2012. v) Education: Matriculation or Army education should be equivalent to matriculation.

Chest 78 Cms. Unexpanded , 83 Cms. Expanded (Minimum 5 Cms. expansion) 76 Cms. Unexpanded, 81 Cms. Expanded ( Minimum 5 Cms. Expansion)

Weight Proportionate height and age as medical standard Proportionate height and age as medical standard to per to per

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vi) Age limit: Age concession for Ex-Servicemen will be allowed in accordance with the orders issued by the Govt. of India from time to time and they will be allowed to deduct Military service from their actual age and such resultant age should not exceed the prescribed age limit by more than three years. 6. Application Fee:The candidates belonging to General and OBC categories will be required to pay Rs.50/(Non-refundable) as application fee in form of IPO or Bank Draft. The Bank Draft or IPO should be prepared in favour of Accounts Officer, Frontier Hqrs. SSB, Lucknow(U.P) payable at SBI, Lucknow(U.P). No fee will be charged from SC/ST and Ex-Servicemen candidates. 7. Place/Venue of Recruitment Rally:- The recruitment will be rally based and the candidates will appear district wise for recruitment at place/venue of recruitment rally i.e. District Armed Police Complex, Chhani Himmat, Jammu (J&K) for the candidates of Jammu region and Armed Police Complex, Zewan, Srinagar (J&K) for the candidates of Srinagar, Leh and Ladakh regions as per following schedule at 0700 hours onwards for initial screening and registration to undergo further test i.e. PST and PET test :Name of Recruitment Centre / Venue Districts from where candidates to appear Jammu District Armed Police Udhampur Complex, Chhani Rajouri Poonch Himmat, Jammu Poonch Reasi Ramban (J&K) Ramban Doda Kishtwar Samba, Kathua Armed Police Srinagar Complex, Zewan, Budgam Anantnag and Srinagar (J&K) Kulgam Pulwama and Shopian Ganderbal and Bandipora Baramulla and Kupwara Kargil Leh Date & Time of reporting for recruitment 10-04-12 & 11-04-12 at 0700 Hrs. 12-04-12 & 13-04-12 at 0700 Hrs 14-04-12 at 0700 Hrs. 15-04-12 at o700 Hrs 16-04-12 at 0700 Hrs 17-04-12 at 0700 Hrs 18-04-12 at 0700 Hrs. 19-04-12 at 0700 Hrs. 20-04-12 at 0700 Hrs. 21-04-12 at 0700 Hrs 10-04-12 at 0700 Hrs. 11-04-12 at 0700 Hrs 12-04-12 at 0700 Hrs 13-04-12 at 0700 Hrs 14-04-12 at 0700 Hrs. 15-04-12 at 0700 Hrs. 16-04-12 at 0700 Hrs 17-04-12 at 0700 Hrs 18-04-12 at 0700 Hrs. 19-04-12 at 0700 Hrs. 20-04-12 at 0700 Hrs. 21-04-12 at 0700 Hrs.

The candidates should report for recruitment at the recruitment venues on the dates mentioned against their district. However, if any candidate is unable to get registered for recruitment rally at respective centre on scheduled dates with valid reason, he may report on subsequent day at that centre, till completion of recruitment at that particular centre. The day of recruitment tests in respect of particular centre may be extended by the respective Recruitment board, if required. 8. Selection Procedure: - Candidates will have to undergo the tests mentioned at (A) to (L):The eligible and willing candidates should report at the designated recruitment venue on the given date and time allotted for their district, with application form duly filled in all respect with signature of candidate along with original certificates. The candidates will undergo stage (A) to (D) of the recruitment process. Failure to qualify in any stage will result in elimination of the candidate from

-4the recruitment process. Following certificates/ testimonials duly attested from a Gazetted officer would be produced by the candidates at the documentation stage after the completion of PST:(i) (ii) (iii) Educational Qualification certificate and mark sheet. Date of Birth certificate (Matriculation certificate for proof of age). Domicile/ Permanent Residential Certificate issued by Revenue authorities not below the rank of Tehsildar/Naib Tehisldar (Candidates having temporary residential certificate for education/ employment purpose will not be entertained.) West Pakistani Refugees settled in J&K are exempted to produce domicile certificate, they will produce certificate issued by the village Sarpanch / Numberdar along with a copy of the Electoral Roll showing the name of the candidate in the voter list for election to the Parliamentary Constituency. Scheduled Caste or Scheduled Tribe certificate as per Annexure-A. Other Backward Class certificate as per Annexure-B. Two recent and identical passport size photographs duly attested by gazetted officer. One should be pasted on the application form and other photograph will bear the name and signature of the candidate on the reverse. Questionnaires form as per Annexure-C duly signed by the candidate Discharge certificate only for Ex-Servicemen. No Objection Certificate in case of persons serving in Govt. organization. An IPO/DD of Rs.50/- for application fee by General and OBC category candidates.

(iv)

(v) (vi) (vii) (viii) (ix) (x) (xi)

Sequence of Recruitment: (A) Height Measurement: - Candidates will be asked to go through the height bar and thereby candidates with lesser height will get eliminated. (B) Registration: Candidates who clear the height measurement test will be registered with the Recruitment Board. They will have to deposit filled up application form and application fee of Rs. 50/for Gen & OBC category candidates. The candidates whose applications are in order and deposit requisite fees will be given registration number for participation of 5 Kms race. (C) Race: - 5 Km. race to be completed in 24 minutes. (D) Physical Standard Test (PST):- Those who qualify the 5 Km race will be screened for height, chest and weight measurements before sending them for Physical Efficiency Test. (E) Biometric verification. (F) Documentation:- The candidates who qualify in the 5 Km race will be required to produce all relevant documents in original along with attested copies as mentioned. (G) Written Examination:- Candidates who qualify 5 Km race, documentation and PST will be required to appear in written examination. (i) The written examination will consist of objective type multiple-choice questions. It will be of 100 marks and comprise 100 questions to be answered in Two hours. The question paper will be set to assess the General Awareness, General Knowledge, Knowledge of elementary Mathematics, analytical aptitude and ability to observe and distinguish patterns and to test the basic knowledge of candidates in English/Hindi. The date and time of written examination will be intimated to the candidates by the recruitment board on completion of 5 Kms race. No separate Call Letter will be issued for appearing in written examination. The qualifying percentage of marks in written test will be 33% for SC, ST candidates and 35% for Ex-Servicemen and General candidates. & OBC

Note : Use of Mobile phone ,camera, calculator devices pager etc. will not be permitted during the Written Examination. (H) Medical Examination:-

The candidates will be medically examined by the Recruitment Board of SSB to assess their physical and medical fitness as prescribed in the eligibility conditions. The number of candidates to be examined will be equal to the number of vacancies, increased by average failure rate during medical examination determined on the basis of past experience. The date of declaration of result of written examination will be intimated to the candidates by the Recruitment Board on the date of written examination and the same will also be uploaded in SSB recruitment website www.ssbrectt.gov.in. No separate call letter will be issued for appearing in Medical Examination. The date wise list of the candidates called for Medical Examination will be

-5pasted in notice board out side of the recruitment venue and will also be uploaded in SSB recruitment website www.ssbrectt.gov.in.
(I)

Appeal against findings of Medical Examination:-

If a candidate is declared unfit in the detailed medical examination, the grounds for rejection will be communicated to him by the Chairman. The rejected candidates will obtain Form 4, 5 & 6 from the Chairman concerned, if not satisfied with the findings of the Medical Officer, to prefer an appeal for Review-Medical Examination with in 15 days from the date of issue of communication in which the finding of the medical officer is communicated to the candidate. The appeal should necessarily contain the following. i) Review Medical Examination fee of Rs. 25/- only (non refundable), through Bank draft in favour of PAO, SSB, MHA payable at State Bank of India, Service Branch, Delhi. ii) Appeal Form 4, 5, and 6 will be issued by the initial Medical Board declaring the candidate unfit. Certificate other than medical Form 6, provided by the recruitment board to the candidates to submit appeal for Review Medical Examination will not be considered and rejected straight way. The fitness certificate on From 6 is essential to consider their cases for Medical Examination and not for any other purpose. The candidate along with Form 4, 5, and 6 duly completed in all respect and IPO/Bank Draft of Rs. 25/- will report to the Review Medical Board for Review Medical Examination. The Chairmen Recruitment Board will intimate the date and time and place of Review Medical Examination where the candidates will have to appear for review medical examination. The decision of the Review Medical Board of SSB will be final and no 2nd appeal will be entertained as per Govt. instructions and also no reply of the correspondence / 2nd appeal will be given / entertained. 9. General instructions:-

a) Candidates should read the instructions very carefully before filling up the application form. b) No change/alteration will be permitted once the form has been submitted. c) Candidates should come duly prepared for 6-7 days stay under their own arrangements at the Recruitment Centre. SSB will not be responsible for damage/injury, if any, to the individual sustained during the Physical Efficiency Test. d) Signature of the candidate throughout the recruitment process should be the same as put in the application form. e) Candidates failing in any of the prescribed tests will be eliminated at that stage. f) Mobile Phone, camera, calculator devices and pager are strictly prohibited in the recruitment venue. g) No separate admit cards will be issued to the qualified candidates called for written examination and Final Medical Examination. The list of qualified candidates called for written examination and Final Medical Examination will be displayed in the notice board at the Recruitment Venue. h) Candidature will be summarily rejected at any stage of the recruitment process for not confirming to the official Format/having incomplete information/wrong information/incomplete requisite certificates/misrepresentation of facts. i) Any sort of canvassing or recommendation will debar the candidate from selection. j) TA for onward and return journey to SC/ST candidates will be paid as per Govt. of India instructions to those who appear in written test subject to production of rail/bus tickets, original caste certificate, non-employment certificate from M.P/MLA or any other Gazetted Officer of the locality in case they are not employed in Central/State Govt. k) Mere qualifying all the prescribed tests in SSB recruitment of Constable (GD) does not confer the right of selection of the candidates but they should have to stand in merit keeping in view the available vacancies. The vacancies are subject to change.

-6l) Success in various stages of recruitment confers no right to appointment unless the department is satisfied after medical examination and such enquiry as may be considered necessary that the candidate is suitable in all respect for appointment to the service/post. m) Candidates have to appear in all the stages of Recruitment for which they have to qualify. If a candidate is absented from any stage/event for which he has to qualify, his candidature will be cancelled. n) On appointment, the candidate shall be governed by SSB Act and Rules and amended from time to time. They shall be entitled for the pension benefits as per the New Restructured Defined Contributory Pension Scheme applicable for the new entrants to the Central Government Services w.e.f. 01.01.2004. o) Selected candidates are required to undergo BRTC in SSB RTCs for which they will be informed separately through offer of appointment letter. They will be on probation for a period of two years which can be extended. During the period of probation, if found unfit for any reason the services are liable to be terminated. p) In case a candidate is found in-eligible for service/post on any ground after his selection/appointment, his services will be terminated without assigning any reason. q) SSB strives to recruit fit, committed, sincere and best candidates with transparency and impartiality. Hence candidates are advised to Beware of Touts. r) The Director General, SSB reserves the right to make changes or cancel or postpone the recruitment without assigning any reason. s) For more information log in our website www.ssbrectt.gov.in. Helpline No.011-26193929, SMS query 9868207689.

ASSISTANT DIRECTOR (RECRUITMENT)

GOVERNMENT OF INDIA, MINISTRY OF HOME AFFAIRS (SASHASTRA SEEMA BAL) APPLICATION FORM FOR SPECIAL RECRUITMENT DRIVE FOR THE POST OF CONSTABLE (GD) 2012 . State Code

Paste a recent Colour Photograph of size 3.5 x 4.5Cms with in the box only duly attested by a

Gazetted Officer
1. Name in BLOCK LETTERS (as recorded in Matriculation Certificate) SURNAME

FIRST NAME MIDDLE 2. Fathers name (as entered in Matriculation Certificate)

3 D D

(a) Date of birth (as in Matriculation certificate) (b) Age as on 01-08-2012 M M Y 1 Y 9 Y Y Y Y M M D D

4. Educational Qualification (Attach CTC of Edu. /Tech. Qualification certificate(s) etc. Exam. Name of School/Board/University/Institute Subject Studied Passed

Aggregate %

5.

Community/Religion: Hindu Muslim Sikh

Christian

Buddhist

Jain

If others, specify

6. Category to which belongsSC (Attached certificate true copy as per Central Govt. instructions). 7. Whether belonging to Domiciled ordly.in J&K during 1980-89 ST OBC GENERAL

In the riots 1984

2002 communal riots of Gujarat

(Attach certificate true copy).

8. Permanent address: Police Station Tehsil. P Contact No: 9. Present address: I N E-Mail ID.

Tehsil P Contact No: E-Mail ID. I N

Police station

Contd2/-

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10. Whether employed in SSB 11. Govt. Service If so, mention following details. Name of present employer Date since when Post held Name and designation of authority issuing N.O.C.

12.. IDENTIFICATION MARK (Please write in the box)

(Unsigned application received if any will be rejected in Toto). Strike out whichever is not applicable*. NOTE: - Candidates should apply only if they fulfill all the physical standard & Educational Qualifications as mentioned in the advertisement to avoid any disappointment at later stage. DECLARATION I hereby declare that all statements made in this application are true and complete and correct to the best of my knowledge and belief. In the event of any information being found false or incorrect or ineligibility being detected before or after the test, my candidature will stand cancelled and my all claims of the recruitment will stand forfeited. I also understand that if at any stage I am found by the Recruitment Board to have used unfair means in the written examination/test or have violated any of the Rules/Regulation governing the conduct of selection process; my candidature can be cancelled or be declared to have failed by the Recruitment Board at its sole discretion. I also declare that, I have never been arrested, prosecuted or convicted by any court of law for any criminal offence. Place: Date:

SIGNATURE OF THE CANDIDATE Contact No. ____________________

DECLARATION/UNDERTAKING FOR OBC CANDIDATES ONLY I, ____________________________________Son/ of Shri__________________________________ resident of village/town/city_________________________ Distt:_________________ State______ hereby declare that I belong to the ______________________community which is recognized as backward class by the Government of India for the purpose of reservation in service as per orders contained in Department of Personnel and Training OM No. 36012/22/93-Estt(SCT), dated 8/9/93. It is also declared that I do not belong to persons/sections (Creamy Layer) mentioned in Column 3 of the Schedule to the above referred OM, dated 8/9/93, which is modified vide Department of Personnel & Training OM No. 36033/3/2004 Estt(Res) dated 9/3/2004 and dated 14/01/2008.

Place: Date:

Signature of Candidate

Annexure-A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE

This is to certify that Shri_________________________________ Son of Shri _____________ _______________________________of village/Town_______________________in District/ Division _____________________ of the State/Union Territory _____________________ belongs to the _____________ caste/Tribe which is recognized as a Schedule Caste/Scheduled Tribe under. The Constitution (Scheduled Castes) order, 1950. The Constitution (Scheduled Tribes) order, 1950. The Constitution (Scheduled Castes)(Union Territory) order, 1951. The Constitution (Scheduled Tribes) (Union Territory) order, 1951. (As amended by the Scheduled Castes and Scheduled Tribes (Modification) Order 1956, the Bombay Reorganization Act, 1960, the Punjab Reorganization Act, 1966, The State of Himachal Pradesh Act, 1970, the North Eastern Areas (Reorganization Act, 1971) and the Scheduled Castes and Scheduled Tribes orders (Amendment) Act, 1976.) *The constitution (Jammu & Kashmir) Scheduled Caste Order, 1956; *The Constitution (Andaman and Nicobar Islands) Scheduled Tribes, 1959, as amended by the Scheduled Castes and Scheduled Tribes orders (Amendment) Act. 1976; *The Constitution ( Dadra and Nagar Haveli) Scheduled Castes Order 1962; *The Constitution (Dadra & Nagar Haveli) Scheduled Tribes Order, 1962; *The Constitution (Pondichery) Scheduled Castes Order, 1964; *The Constitution (Uttar Pradesh) Scheduled Tribes Order, 1967; *The Constitution (Goa, Daman & Dieu) Scheduled Castes Order, 1968; *The Constitution (Goa, Daman & Dieu) Scheduled Tribes Order, 1968; *The Constitution (Nagaland) Scheduled Tribes Order, 1970; *The Constitution (Sikkim) Scheduled Castes Order, 1978; *The Constitution (Sikkim) Scheduled Tribes Order, 1978; *The Constitution (Scheduled Castes) Orders (Amendment) Act, 1990. *The Constitution (Scheduled Tribes) Order, (Amendment) Ordinance, 1991. *The Constitution (Scheduled Tribes) Order, (Second Amendment) Act, 1991. The Constitution (Scheduled Tribes) Ordinance, 1996 *2. This certificate is issued on the basis of the Scheduled Castes/Scheduled Tribes Certificate issue to Shri _____________________________________Father of Shri _________________________ ______of village/town________________________ in District/Division _____________________ of the State/UT _________________ _____________who belong to the ____________ caste/Tribe which is recognized as a SC/ST in the State/Union Territory __________________________ issued by the _______________________________ ( name of the prescribed issuing authority) vide their No. ______________________________________ dated _____________ or Shri ____________ __________________ and or his/her family ordinarily reside(s) in Village/Town _____________of ____________ District/Division of the State/Union Territory of _______________. Place______________ Date_______________ Signature______________ Designation ____________ (With seal of Office) NOTE:- The terms ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act, 1950.

ANNEXURE-B FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE CENTRAL GOVERNMENT OF INDIA.

(G. I. Dept. of Per.& Trg. O. M. No.36033/28/94-Estt.(Res).dated 2-7-1997) This is to certify that son of . Village .. District/Division. In the State belongs to the.. Community, which is recognized as a Backward Class under: * (i) Government of India, Ministry of Welfare, Resolution, No.12011/68/93-BCC (C),
dated the 10th September, 1993, published in the Gazette of India, Extraordinary, Part-I, Section-I, NO. 186, dated the 13th September, 1993. *(ii) Government of India, Ministry of Welfare, Resolution No.12011/9/94-BCC, dated the 19th October, 1994, published in the Gazette of India, Extraordinary, Part-I, Section, No. 163 dated the 20th October, 1994. *(iii) Government of India, Ministry of Welfare, Resolution No.12011/7/95-BCC, dated the 24th May, 1995, published in the Gazette of India, Extraordinary, Part-I, Section I, No. 88, dated the 25th May, 1995. *(iv) Government of India, Ministry of Welfare, Resolutiion No.12011/44/96-BCC, dated the 9th March, 1996, published in the Gazette of India, Extraordinary, Part-I, Section I, No. 60, dated the 11th March, 1996. *(v) Government of India, Ministry of Welfare, Resolution No.12011/44/96-BCC, dated the 6th December 1996, published in the Gazette of India, Extraordinary, Part-I, Section I, No. 210, dated the 11th December 1996. *(vi) Government of India, Ministry of Welfare, Resolutiion No.12011/13/97-BCC, dated the 3rd December, 1997, published in the Gazette of India, Extraordinary, Part-I, Section I, No. 239, dated the 17th December, 1997. *(vii) Government of India, Ministry of Welfare, Resolution No.12011/99/94-BCC, dated the 11th December 1997, published in the Gazette of India, Extraordinary, Part-I, Section I, No. 236, dated the 12th December 1997. *(viii) Government of India, Ministry of Welfare, Resolutiion No.12011/68/98-BCC, dated the 27 Oct., December, 1999, published in the Gazette of India, Extraordinary, Part-I, Section I, No. 241, dated the 27th Oct, 1999. *(ix) Government of India, Ministry of Welfare, Resolution No.12011/88/98-BCC, dated the 06th December 1999, published in the Gazette of India, Extraordinary, Part-I, Section I, No. 270, dated the 06th December 1999. *(x) Government of India, Ministry of Welfare, Resolutiion No.12011/36/99-BCC, dated the 4th April 2000, published in the Gazette of India, Extraordinary, Part-I, Section I, No. 71, dated the 4th December 2000. *(xi) Government of India, Ministry of Welfare, Resolution No.12011/44/99-BCC, dated the 21st December 2000, published in the Gazette of India, Extraordinary, Part-I, Section I, No. 210, dated the 21st December 2000. *(xii) Government of India, Ministry of Welfare, Resolutiion No.12011/44/99-BCC, dated the 6th September, 2001, published in the Gazette of India, Extraordinary, Part-I, Section I, No.246, dated the 6th September, 2001 Shri..and/or his family ordinarily reside(s) in the . District/ Division of the State. This is also to certify that he/she does not belong to the persons/sections (Creamy Layer) mentioned in Column 3 of the schedule to the Government of India, Department of Personnel, and Training, O. M. No. 36012/22/93-Estt. (SCT), dated 8-9-1993. DISTRICT MAGISTRATE/ DEPUTY COMMISSIONER/ TEHSILDAR ETC. OFFICE SEAL

Dated:

Strike out which ever is not applicable

LIST OF AUTHORITIES EMPOWERED TO ISSUE CASTE/TRIBE CERTIFICATE:

1. District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner /Additional Deputy Commissioner/Dy. Collector/ 1st Class Stipendiary Magistrate/Sub Divisional Magistrate/Extra Assistant Commissioner/ Taluka Magistrate/Executive Magistrate. 2. Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate. 3. Revenue Officers not below the rank of Tehsildar/Naib Tehsildar 4. Sub-Divisional Officers of the area where the candidate and / or his/her family resides.

ANNEXURE-C QUESTIONNARIE FORM 1. 2. 3. 4. Have you ever been convicted by any court of law or any other judicial institution? Is there any case pending against you in any court of law? Has any FIR ever lodged and case is pending against you? Was any FIR ever lodged against you in the past? a) If yes case No. and Section under which FIR was lodged? b) Name of the Police Station where FIR was lodged? c) Was the case charge sheeted or returned in FIR? d) If the case charge sheeted, what was the outcome in court? i) Convicted ii) Acquitted iii) Compromised iv) Compounded v) Any other, please specify 5. 6. Have you ever been dismissed from any service under the Central or State Govt.? Have your services ever been terminated while on probation? If the answer to any of the above is YES then please provide complete details on a separate Sheet. Yes/No Yes/No Yes/No Yes/No

Undertaking

I,___________________________ declare that the above information is true to the best of my knowledge and belief. I under stand that in case information is found to be false or incorrect my candidature is liable to be cancelled apart from any departmental or legal proceedings that may be initiated against me.

Place:Date:Signature of Candidate Name________________ Fathers Name ___________________ Address_________________________

davp/19114/11/0001/1213