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CENTRAL INDUSTRIAL SECURITY FORCE

APPLICATION FORM FOR RECRUITMENT OF HEAD
CONSTABLE/MIN-2019
1.)Application Number HCM1902505010
2.)Post Applied for HC/MIN
3.)Candidate Name KARIMIREDDY SIVAJI

4.)Fathers's Name KARIMIREDDY APPALANAIDU

5.)Date of Birth 24-07-1994

6.)Gender male
7.)Nationality INDIAN
8.)Religion HINDU
9.)Category OBC
10.)Belongs to Hill Area NO
11.)Are you Child / dependent of victims
KILLED in the 1984 riots/2002 communal NO
riots in Gujarat ?
12.)Were you domiciled in the State of J & K
during the period from 1st Jan 1980 to 31st NO
Dec 1989?
13.)Whether you are a ward of West
NO
Pakistani Refugee(WPR) settled in J & K ?
14.)(A)Communication Address:
(B)Permanent Address:
H.No: 5-48
H.No: 5-48
Village: BOMMURU 14
Village: BOMMURU 14
RAJAMAHENDRAVARAM HEAD
Post: Post: RAJAMAHENDRAVARAM HEAD OFFICE
OFFICE
PS: BOMMURU
PS: BOMMURU
District: EAST GODAVARI
District: EAST GODAVARI
State: ANDHRA PRADESH
State: ANDHRA PRADESH
Pincode:533124
Pincode:533124
15.)Identification Marks: (a)A MOLE ON THE RIGHT SIDE OF NOSE
(b)A MOLE ON THE LEFT UPPER ARM
16.)Educational Details: Civil:GRADUATION
Army:
17.)EX-SERVICEMEN: N/A
18.)CISF PERSON: N/A
19.)GOVERNMENT EMPLOYEE: N/A
20.)Fee Details: Reference Number CPN6501398
Amount 100
Status Success
21.)Have you ever been convicted by any
court of law or any other judicial NO
Institution?

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22.)Is there any case pending against you in

NO
any court of law?
23.)Has any FIR been lodged and case is
NO
pending against you?
27.)Was any FIR ever lodged against you in
NO
the past?
24.)Have you ever been dismissed from any
NO
service under the Central or State Govt.?
25.)Have your services ever been
NO
terminated while on probation?
DECLARATION

(i) I hereby certify and declare that all the statements made in the application are true, complete and correct to the best
of my knowledge and belief. In the event of information or part thereof being found false or detected incorrect during
the process of recruitment or at any stage thereafter and that i am not satisfying the eligibility criteria prescribed in this
notice, my candidature/appointment is liable to be cancelled/terminated automatically without any notice to me and
action can be taken against me by the CISF.

(ii) I have read the provisions in the notice of the examination carefully and hereby undertake to abide by them.

(iii) I Further declare that I fulfill all the conditions of eligibility regarding age limits, educational qualifications, etc.
prescribed for admission to the examination. I have enclosed photocopies of certificates in support of claim for
Educational Qualifications, age, category (SC/ST/OBC) and age relaxation etc.

(iv) I also declare that I do not stand debarred from Government Service as on date and have never been convicted by
any court of law.

(v) I have not submitted any other application for this examination. I am aware that if I contravene this rule, my
application will be rejected summarily.

(vi) * For Employees of CISF seeking age relaxation.

  I declare that I am serving in CISF and completed 3 years regular service or regular length of service stipulated in
the Notice of the examination on or before date of closing submitting application form given in the notice.

(vii) * For Candidate belonging Ex-Servicemen.

  I declare that I fulfill all the eligibility conditions relating to Ex-Servicemen as per Notice of Examination.

(viii) * For Candidate belonging to OBC.

  I declare that I belong to the community which is recognized as a backward class by the Govt. of India for the
purpose of reservation in services as per order contained the Department of Personnel and Training Office
Memorandum No.36012/22/93-Estt(SCT) dated 8-9-1993. I also declare that I do not belong to the
person/sections(Creamy Layer) mentioned in column 3 of OM No.36012/22/93-Estt.(SCT) dated 8-9-1993 and
modified vide Government of India DOP&T OM.36033/3/2004-Estt.(Res.) dated 9-3-2004.

Singnature

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