Policc Form Mahbub

7/28/2019 Policc Form Mahbub

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GOVT. OF THE PEOPLES REPUBLIC OF BANGLADESH

MINISTRY

DIVISION

OFFICE

Verification Roll for candidates selected for appointment under the Central

Government

The name of the post in :which the candidate is to beappointed: Assistant Programmer

Part 1. To be filled in by the candidate

1 Name in full (in block letter)with aliases, if any andNationality

: S M Mahbub Alam

Bangladeshi

2 Fathers name in full withDesignationof Service, if any and Nationality

: Md. Shamsul Haque

Bangladeshi

3. Home Address in full ( i.e.Village, Post Office, P.S./Upa-Zilla & District)

: Plot#1524, House# 26,Lane#3, Minabag (Paterbag),South Donia, Dhaka-1236

4 Present Residential address : Plot#1524, House# 26,Lane#3, Minabag (Paterbag),South Donia, Dhaka-1236

5 Local & other address during thelast five years where thecandidate has stayed for more

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than six months

Address From To

Plot#1524, House# 26, Lane#3, Minabag (Paterbag),South Donia, Dhaka-1236

July, 2007 Till Now

6 Date of Birth (where the candidate is amatriculate his matric age should benoted

: 01-01-1982

7 Place of Birth (Village, Post office,

P.S./ Upa-Zilla & District)

: village: Chandpura,Thana: Barisal Sadar,Dist: Barisal

8 Educational Qualification showing places of education with years inschools and colleges from 14th years of the candidate.

No. Name of School/College/University

DateofEntry

Date ofLeaving

Exam.Passed

Div/Class Year

1. Islamic University,Kushtia

January,2001

June,2007

B.Sc(Hons)

2nd Class 6 years and6 months

2. Govt. Science College,Dhaka

July,1997

July,1999

H.S.C 1st 2 years

3. A.K. High School January,1995

March,1997

S.S.C 1st 2 years

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9. Offices of firms with full description and address where the candidate

previously worked and reason of leaving.

(If the candidate has previous service in the armed force Bangladesh

relevant entries relating to the length of service, nature of the duties

performed and report regarding the character of behavior in the Discharge

Certificate should be entered).

Note: The Ministry/ Division/ Office should satisfy themselves that the

discharge certificates of ex-service men are satisfactory.

10.

Whether arrested, prosecutedorconvicted in any case, Politicalor otherwise and restricted orextended , if so full particularsincluding dates should be

furnished

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11.

Full particulars of the near relations, if any i.e. brothers, sisters, firstuncles first relations in law, who are in Govt. Service in Bangladesh orelsewhere, specifying the posts held and where posted.

Name of relation Post held Place of duty

12. A certificate of character from of the head of the educations institution

last

attended by the candidate to be attached.

13. Name with address Of two Reference in Bangladesh , who can testify to

the

candidates character and antecedents.

Name Address

1.

2.

Date: (Signature)

Name :

Designation :

Branch/ Dept. :

Division :

Part II. To be filled in by the Sudt. Of Police etc. concerned at the request

of Ministry/Division/Office

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Suitable/Unsuitable for the following reasons

Place :............................... Superintendent of Police

Note : After verification of character and antecedents of the concerned by the

police, the verification roll should be passed on by the Superintendent of Police for

return to the authorities concerned through the D.I.B.

Countersigned: Asstt. Director

For Director, Intelligence...................

To,

Please take necessary action to get the character and antecedents onMr............................

....................verified and return enclosed roll duly completed to the undersigned.

Signature & Designation of theissuing Officer and the name of

theMinistry/Division/Office

with full address and date.

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Policc Form Mahbub

Documents

Transcript of Policc Form Mahbub