APPLICATION FOR THE POST OF CONSTABLE (TECHNICAL/TRADE) IN

CENTRAL RESERVE POLICE FORCE

FOR OFFICE USE ONLY Recent passport size photograph

ACCEPTED/REJECTED

Reasons for Rejection…………

Applied post ------------ 1. Name of applicant in BLOCK LETTERS (As recorded in Matriculation Certificate)

2. Father’s name (As recorded in Matriculation Certificate)

3. Mother’s name (As recorded in Matriculation Certificate)

4. Caste/Category (Tick √ the correct one): SC ST OBC Genl

5. Nationality (State whether by birth or domicile)

6. Name of State

7. Date of Birth (in Christian era)

D D M M Y Y Y Y

(Age as on 01/01/2015) Year Month Days

8. Permanent address:- House Name/No Street Village PO PS Tehsil District State Pin 9. Present Postal Address:- House Name/ No. Street Village PO PS Tehsil District State

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Pin 10. Religion (Tick √ the correct one)

Hindu Muslim Sikh Christian Budhist Others 11. Educational qualification (Tick √ the correct one)

Matric or Intermediate or Graduate Post equivalent 10+2 Graduate

12 Name of Trade/Post applied for ::

(Each candidate is allowed to apply

for one trade only)

13 Trade qualification (if any) ::

14. Physical Standard ::

(a) Height (in Cms)

Cms

(b) Chest Measurement Un-expanded : Cms (For male candidates only) Expanded : Cms

(c) Weight Kgs.

15. Particulars of present employment :: If any with post and service

Number/name of department etc.

16. Are you Ex-servicemen :: Yes/No

17. Whether claiming age relaxation :: Yes/No 18. IPO/Bank Demand draft No date and

:: Issuing branch (Male Genl & OBC categories candidates only)

19. Whether four self addressed envelopes:: Yes/No duly affixing postage stamps for Rs.27/-

enclosed (By all candidates)

20. Whether Ward of Serving CRPF person:: Yes/No 21. If Ward of serving CRPF person, :: Force No.______________ Rank______

details of serving Father/Mother be given Name ___________________________ Unit/Office _______________________

DECLARATION

I do hereby declare that all statements made in this application are true, complete and correct to the best of my knowledge and belief. In the event of any information being found false or incorrect or ineligible being detected before or after the test, my candidature will stand cancelled and all my claims of the recruitment will stand forfeited. I also understand that if at any stage I am found by the selection board to have used unfair means in the PET/PST/Written examination/trade test etc or to have violated any of the Rules/Regulations governing in the conduct of selection process, my candidature can be cancelled or be declared to have failed by the selection board at its sole discretion.

(_____________________) Signature of the applicant

Place : ……………………….. (Application not signed by the candidate will be rejected) Date : …………………………

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Appendix-B

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

This is to certify that Shri/Smt*/Kumari …………………………………………… son/daughter* of Shri …………………………………………………………. of village/town* ……………………………… in District/Division* …………………………….. of State/Union

Territory*…………………………….belongs to the ……………………………….Caste/Tribe* which is recognized as Scheduled Caste/Schedules Tribe* under:-

The Constitution (Scheduled Caste) Order, 1950. *The Constitution (Scheduled Tribes) Order, 1950. *The Constitution (Scheduled Caste) (Union Territories) Order, 1951.

*The Constitution (Scheduled Tribes) (Union Territories) Order, 1951.

{As amended by the Scheduled Castes and Scheduled Tribes List (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 Order, 1959, as

amended by the Scheduled Castes and Scheduled Tribes Order (Amendment) Act,

1976. *The Constitution (Dadra and Nagar Haveli) Scheduled Castes Order, 1962.

*The Constitution (Dadra and Nagar Haveli) Scheduled Tribes Order, 1962.

*The Constitution (Pondichery) Scheduled Castes Order, 1964. *The Constitution (Utter Pradesh) Scheduled Tribes Order, 1967. *The

Constitution (Goa, Daman & Diu) Scheduled Castes Order, 1968. *The

Constitution (Goa, Daman & Diu) 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 (Jammu & Kashmir) Scheduled Tribes Order, 1989.

*The Constitution (Scheduled Caste) Orders (Amendment) Act, 1990.

*The Constitution (Scheduled Tribes) Orders (Amendment) Act, 1991. *The Constitution (Scheduled Tribes) Orders (Second Amendment) Act, 1991.

*The Constitution (ST) orders (Amendment) Ordinance 1996 *%2. Applicable in the case of Scheduled Castes, Scheduled Tribes persons who have

migrated from one State/Union Territory Administration

Contd….P/2

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P/2

2. **This certificate is issued on the basis of the Scheduled Castes/Scheduled Tribes

Certificate issued to Shri/Smt*/Kumari …………………………………………… son/daughter* of Shri …………………………………………………………. of village/town* ……………………………… in

District/Division* …………………………….. of State/Union

Territory*…………………………….belongs to the ……………………………….Caste/Tribe* which is recognized as Scheduled Caste/Schedules Tribe* in the State/Union Territory*

issued by the ………………………………………. dated……………………………….

3. Shri/Smt*/Kumari …………………………………………… and/or* family ordinarily reside

(s) in village/town* ……………………………… in District/Division*

……..…………………………….. of State/Union Territory* of …………………….

Place : ……………..

Date : …………….. Signature………………….. Designation………………. (With seal of Office)

Note : (The terms “Ordinarily resides” used here will have the same meaning as in

Section – 20 of the Representation of the Peoples Act, 1950)

* Please delete the words which are not applicable. ** Applicable in case of SCs, STs Persons who have migrated from one

State/UT.

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 / Taluka Magistrate / Executive Magistrate / Extra Assistant Commissioner.

2. Chief Presidency Magistrate / Additional Chief Presidency Magistrate / Presidency

Magistrate. 3. Revenue Officers not below the rank of Tehsildar. 4. Sub Divisional Officers of the area where the candidate and / or his

family normally resides. NOTE: ST candidates belonging to Tamil Nadu state should submit caste

certificate ONLY FROM THE REVENUE DIVISIONAL OFFICER.

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APPENDIX-C

FORM OF CERTIFICATE TO BE PRODUCED BY CANDIDATES BELONGING TO OTHER BACKWARD CLASSES APPLYING TO POSTS UNDER THE GOVERNMENT OF INDIA

This is to certify that Shri/Smt/Kumari ____________________son/daughter of ____________________________ of village/town _________________ in

District/Division_________________________________ in the State/Union Territory _____________________belongs to the ________________________community which is

recognised as a backward class under the Government of India, Ministry of Social Justice

and Empowerment’s Resolution No. __________________________dated _______*.

Shri/Smt/Kumari __________________________________and/or his/her family ordinarily

reside(s) in the ____________________________________District/Division of the ____________________State/Union Territory. 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 & Training O.M.No. 36012/22/93-

Estt.(SCT) dated 08/09/1993**.

District Magistrate

Deputy Commissioner etc

Dated:

Seal ________________________________________________________________________

* - The authority issuing the certificate may have to mentioned the details of Resolution of Government of India, in which the caste of the candidate is mentioned as OBC. ** -As amended from time to time. Note:- The term “ Ordinarily ”used here will have the same meaning as in Section 20 of the

Representation of the People Act, 1950.

28

Appendix-D

FORM OF CERTIFICATE TO BE SUBMITTED BY THOSE CANDIDATES WHO INTEND

TO AVAIL RELAXATION IN HEIGHT OR CHEST MEASUREMENT

Certified that Shri/Smt/Kumari __________________________________ Son/Daughter of Shri ________________________ is permanent resident of village

______________________, Tehsil/Taluka_____________________________

District_____________________ of ________________________________ State.

2. It is further certified that:- * Residents of entire area mentioned above are considered as Garhwali/

Kumaoni/Dogras/ Marathas for relaxation in height and chest measurement for recruitment in the Para Military forces of the Union of India.

* He/ She belongs to the States of Sikkim/Himachal Pradesh/(Jammu &

Kashmir) / North-Eastern States/candidates hailing from Gorkha Territorial Administration (GTA) comprising of the three sub-Divisions of Darjeeling District namely Darjeeling, Kalimpong and Kurseong and including the following “Mouzas” sub Division of these districts, which is considered for relaxation in height and chest measurement for recruitment in the Para Military forces of Union of India.

(1) Lohagarh Tea Garden (2) Lohagarh Forest (3) Rangmohan (4)

Barachenga (5) Panighata (6) Chota Adalpur (7) Paharu (8) Sukna Forest (9) Sukna Part-I (10) Pantapati Forest –I (11) Mahanadi Forest (12) Champasari Forest (13) Salbari Chhat Part-II (14) Sitong Forest (15) Sivoke Hill Forest (16) Sivoke Forest (17) Chhota Chenga (18) Nipania

* He/she hailing from LWE affected areas/districts (i.e. Gadchiroli, Chandrapur, Gondia Districts of Maharashtra State, Warrangal,

Karimnagar, Adilabad, Khammam, Medak, Nalgonda, Guntur,

Nizamabad, Mahboobnagar, Prakasam, Anantapur, Kurnool, Vizianagaram, Vishakhapatam, East Godavari and Srikakulam Districts of Andhra Pradesh) which is considered for relaxation in height and chest measurement for recruitment in the Para Military forces of Union of India.

* He/She belongs to Scheduled Tribe. Date: Place:

Signature District Magistrate/ Sub-Division Magistrate/ Tehsildar

With Seal

* Delete whichever is not applicable

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APPENDIX-E

CERTIFICATE FOR SONS/DAUGHTERS OF SERVING CRPF PERSONNEL

Certified that _______________________________________ is son/

daughter of No._________________________________ Rank ______________ Name

____________________________________, who is posted in

_____________________________________________________ (Name of Bn/Office with

location). It is also certified that the above ward is residing with the serving Force person.

The name of the above Son/Daughter has been verified from the service records of the

serving Force personnel.

Signature of Head of office

Name of H.O.O __________________________

Rank___________________________

Unit____________________________

Note : One copy of the certificate is to be kept in the Service record of the

serving personnel.

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Appendix-F MEDICAL FITNESS CERTIFICATE

Certified that Mr./Ms…………………………………………………………. Age……… years, a

candidates of recruitment of Constable (Tech/Trade) in CRPF was examined by me at Hospital…………………………………………………………………on date……………. 2. I, the undersigned have the knowledge that Mr./Ms. ………………… ……………………………………………………………………………………………………………………………… has been declared Medically Unfit by the Medical Officer during recruitment of Constable(Tech/Trade) in CRPF due to :-

In my opinion this is an error of judgement due to following reasons :- 3. After due examination, I declare him/her medically fit for the said post.

Signature & Name with seal

of Medical Practitioner Registration

No…………… (MCI/State Medical Council)

Address………………………

Dated: ……………………………….

…..…………………………….

Signature of the Candidate Attested by

The Medical Practitioner Signature & seal

Note : The findings of the Medical Practitioner should be supported by Medical reports/

documents wherever applicable. Details of the Full Notification click here- privatejobshub.blogspot.in/2012/10/crpf-

recruitment-2012-13-crpfnicin.html