KARNATAKA STATE POLICE SUB INSPECTOR RECRUITMENT - 2019

( ISO : 9001 - 2015 Certified Recruitment Process )

APPLICATION FOR THE POST OF POLICE SUB-INSPECTOR(CIVIL)(MEN & WOMEN) - 2019

¥ÉÆ°Ã¸ï ¸À¨ï-E£ïì¥ÉPÀÖgï (¹«¯ï) (¥ÀÄgÀĵÀ ªÀÄvÀÄÛ ªÀÄ»¼Á)ºÀÄzÉÝUÉ Cfð - 2019
C¢ü¸ÀÆZÀ£É ¸ÀASÉå : 84/£ÉêÀÄPÁw-2/2019, ¢£ÁAPÀ:
Application No : 1605853 Applying as a : Direct Candidate
Post : PSI (CIVIL)
01 Applicant's Full Name / CfðzÁgÀ£À : MANUKUMAR B K
¥ÀÆtð ºÉ¸ÀgÀÄ
02 Mother's Name / vÁ¬ÄAiÀÄ ºÉ¸ÀgÀÄ : PREMA
03 Father's Name / vÀAzÉAiÀÄ ºÉ¸ÀgÀÄ : KRISHNAMURTHY BM
04 Gender / °AUÀ : Male
06 Offer your preferences as to which Range/ Commissionerate you are Interested to work / DzÀåvÉAiÀÄ C£ÀĸÁgÀ PÀvÀðªÀå : PSI(CIVIL)
¤ªÀð»¸À®Ä EaѸÀĪÀ ªÀ®AiÀÄ / PÀ«ÄõÀ£ÀgÉÃmï w½¹

1 Bangalore City Priority 1

2 Mysore City Priority 3
3 Mangaluru City Priority 7
4 Hubballi- Dharwad City Priority 9
5 Belagavi city Priority 5
6 Western Range, Mangalore Priority 4
7 Eastern Range, Davangere Priority 6
8 Northern Range, Belagavi Priority 8
9 Central Range, Bengaluru Priority 2
07 Address / «¼Á¸À : 262,ANJANEYA TEMPLE
ROAD,BELAVADI,CHIKKMAGALURU,Chikkamagaluru,Karnataka,577146

7a Native District / ¸ÀéAvÀ f¯Éè : Chikamagalur 7b Other / EvÀgÉ : N/A

08 Email Id / E-ªÉÄïï Lr : manukumarbk1@gmail.com 09 Mobile Number / ªÉƨÉÊ¯ï ¸ÀASÉå. : 8495937054
10 Category / ¥ÀæªÀUÀð : 2A 10 Aadhar Card No /DzsÁgï PÁqïð ¸ÀASÉå : 386889322483
10a Caste / eÁw : kuruba 10b Date of issue of Caste Certificate / eÁw : 20 Nov 2017
¥ÀæªÀiÁt ¥ÀvÀæ «vÀgÀuÁ ¢£ÁAPÀ
Height of the Candidate / C¨sÀåyðAiÀÄ JvÀÛgÀ : 171 Weight of the Candidate / C¨sÀåyðAiÀÄ vÀÆPÀ : N/A

14 Do you belong to a family of an : No 14a Death while in service / PÀvÀðªÀå : No

Ex-servicemen who while in service was ¤ªÀð»¸ÀĪÁUÀ ªÀÄgÀt ºÉÆA¢zÀÝgÉ
permanently disabled or died in action ? /
¤ÃªÀÅ, PÀvÀðªÀåzÀ°è ±Á±ÀévÀªÁV zÉÊ»PÀ «PÀ®vÉ
CxÀªÁ ªÀÄgÀt ºÉÆA¢zÀ ªÀiÁf ¸ÉʤPÀ£À
PÀÄlÄA§PÉÌ ¸ÉÃjgÀÄ«gÁ?
14b Permanently disabled while in Service / : No 14c Wife, Husband, Children, Step : No
PÀvÀðªÀå ¤ªÀð»¸ÀĪÁUÀ ±Á±ÀévÀ «PÀ®vÉ Children / ºÉAqÀw, UÀAqÀ, ªÀÄPÀ̼ÀÄ,
ºÉÆA¢zÀÝgÉ ªÀÄ® ªÀÄPÀ̼ÀÄ
14d Relationship / ¸ÀA§AzsÀ : N/A 14e Date of issue of Dependent : N/A
Certificate / CªÀ®A©vÀ ¥ÀæªÀiÁt ¥ÀvÀæ
«vÀgÀuÁ ¢£ÁAPÀ
15 Rural / UÁæ«ÄÃt : No 15a Date of issue of Certificate / : N/A
¥ÀæªÀiÁt¥ÀvÀæ «vÀgÀuÁ ¢£ÁAPÀ

16 Kannada Medium / PÀ£ÀßqÀ ªÀiÁzsÀåªÀÄ : No 16a Date of issue of Certificate / : N/A

17 PDP / AiÉÆÃd£Á ¤gÁ²ævÀ C¨sÀåyð
18 Are you a candidate belonging to
Hyderabad-Karnataka Region ? /
ºÉÊzÀgÁ¨Ázï-PÀ£ÁðlPÀ ¥ÀæzÉñÀzÀ C¨sÀåyðAiÉÄÃ?
¥ÀæªÀiÁt¥ÀvÀæ «vÀgÀuÁ ¢£ÁAPÀ
: No 17a Date of issue of Certificate / : N/A
¥ÀæªÀiÁt¥ÀvÀæ «vÀgÀuÁ ¢£ÁAPÀ
: No 18a If yes, to which District you belong : N/A
to ? / ºËzÁzÀ°è, AiÀiÁªÀ f¯ÉèUÉ
¸ÀA§A¢ü¹¢ÝÃgÁ ?
19 Are you claiming for the local cadre posts Reserved for Hyderabad-Karnataka Region? / ºÉÊzÀgÁ¨Ázï-PÀ£ÁðlPÀ : No
«ÄøÀ¯ÁwAiÀÄ ¸ÀܽÃAiÀÄ ªÀÈAzÀzÀ ºÀÄzÉÝUÀ½UÉ DAiÉÄÌ PÉÆÃgÀÄ«gÁ?
19b Give your priority in case you are eligibility for both Local & Non-Local Cadre reserved posts? / ¤ÃªÀÅ ¸ÀܽÃAiÀÄ ªÀÈAzÀzÀ «ÄøÀ¯Áw
ºÀÄzÉÝUÀÆ ªÀÄvÀÄÛ ¸ÀܽAiÉÄÃvÀgÀ ªÀÈAzÀ «ÄøÀ¯Áw ºÀÄzÉÝUÉ CºÀðvÉ ºÉÆA¢zÀÝ°è AiÀiÁªÀ ªÀÈAzÀzÀ ºÀÄzÉÝUÉ DAiÉÄÌ §AiÀĸÀĪɣÉAzÀÄ DzÀåvÉ ¤Ãr?

N/A

21 Are you a Government Employee ? /¤ÃªÀÅ : No 21a Designation / ¥ÀzÀ£ÁªÀÄ : N/A

¸ÀPÁðj £ËPÀgÀgÉÃ?
21b Department / E¯ÁSÉ : N/A 21c Service rendered / ¸À°è¹zÀ ¸ÉêÁªÀ¢ : N/A N/A N/A
21d Date of issue of NOC / ¤gÁPÉëÃ¥ÀuÁ : N/A
¥ÀæªÀiÁt ¥ÀvÀæ «vÀgÀuÁ ¢£ÁAPÀ
22 Date of Birth (as in SSLC or its : 11 May 1996 ( Your Age is 23 Years, 2 Months, 25 Days as on cut off date 05/08/2019 )
equivalent Marks Card) / ºÀÄnÖzÀ ¢£ÁAPÀ
(J¸ïJ¸ïJ¯ï¹ CxÀªÁ vÀvÀìªÀiÁ£À CAPÀ
¥ÀnÖAiÀÄ°ègÀĪÀAvÉ)
23 Have you been involved in any Criminal : No 23a give details / «ªÀgÀ ¤ÃqÀĪÀÅzÀÄ : N/A
Case / Departmental Enquiry ? /
AiÀiÁªÀÅzÁzÀgÀÆ C¥ÀgÁzsÀ ¥ÀæPÀgÀtzÀ°è /
E¯ÁSÁ «ZÁgÀuÉAiÀÄ°è zÉÆöAiÀiÁV¢ÝÃgÁ ?
24a Have you been convicted in a Criminal : No 24a give details / «ªÀgÀ ¤ÃqÀĪÀÅzÀÄ : N/A
Case ? / ¤ÃªÀÅ C¥ÀgÁzsÀ ªÉÆPÀzÀݪÉÄAiÀÄ°è
²PÉëUÉ M¼À¥ÀnÖgÀÄ«gÁ?
Qualification Details
25 Are you a Degree holder or holder of a : Yes 25a Which Degree / AiÀiÁªÀ ¥ÀzÀ« : BACHEALOR OF
Equivalent qualification from Recognized ENGINEERING
University ? / ¤ÃªÀÅ CAVÃPÀÈvÀ
«±Àé«zÁå®AiÀÄ¢AzÀ ¥ÀzÀ« CxÀªÁ vÀvÀìªÀiÁ£À
«zÁåºÀðvÉ ºÉÆA¢gÀÄ«gÁ?
25b Year Of Passing / GwÛÃtðgÁzÀ ªÀµÀð : 2017 25c Have you studied kannada language : Yes
in S S L C Examination as First or
25d Have you obtained your degree from a : Regular Course Second language?
Regular University / Distance Open/¤ÃªÀÅ 25e Percentage : 69
¸ÁªÀiÁ£Àå ¥ÀzÀ«AiÀÄ£ÀÄß ¥ÀÆtðUÉƽ¹¸À¢ÝgÁ
CxÀªÁ ªÀÄÄPÀÛ «±Àé«zÁå®AiÀÄ / zÀÆgÀ ²Pàët
25g Date of Announcement of the : 07 Jul 2017
¥ÀzÀ«AiÀÄ£ÀÄß ¥ÀqÉ¢¢ÝgÁ ?
Final Degree Result?
25f Which State ? / AiÀiÁªÀ gÁdå? : Karnataka
25h Which University ? /AiÀiÁªÀ «±Àé«zÁå®AiÀÄ? : VTU BELAGAVI

Acceptable Identity cards

26. Select the Uploading Identity Card?

C¥ï¯ÉÆÃqï ªÀiÁqÀĪÀ UÀÄgÀÄw£À aÃnAiÀÄ£ÀÄß DAiÉÄÌ
: AADHAR CARD 27 Identify Card No.
UÀÄgÀÄw£À aÃnAiÀÄ ¸ÀASÉå
: 386889322483
ªÀiÁqÀĪÀÅzÀÄ

Fees Details
28 Date of Challan Generation / ZÀ®£ï : 17 Jul 2019 29 Fee Paid /¥ÁªÀw¹zÀ ±ÀÄ®Ì : 250
¸ÀÈf¹zÀ ¢£ÁAPÀ
30 Date of Payment / ±ÀÄ®Ì ¥ÁªÀw¹zÀ ¢£ÁAPÀ : 06 Aug 2019 31 Journal No./ Trans Serial : SL0023290041565077602
d£Àð¯ï ¸ÀASÉå
32 Bank / Post Office Branch/ ¨ÁåAPï / CAZÉ PÀbÉÃj : 560000 33 Bank / Post Office/¨ÁåAPï / CAZÉ : PostOffice
±ÁSÉ PÀbÉÃj

34 Bank / Post Office Address /¨ÁåAPï / CAZÉ PÀbÉÃj : N/A

«¼Á¸À
I Agree/ £Á£ÀÄ M¦àgÀÄvÉÛãÉ.
¥sÉÆõÀuÉ
1. CfðAiÀÄ°è w½¹gÀĪÀ «ªÀgÀUÀ¼ÀÄ £À£ÀUÉ w½zÀ ªÀÄnÖUÉ ªÀÄvÀÄÛ £À£ÀÄ £ÀA§ÄªÀµÀÖgÀ ªÀÄnÖUÉ ¤dªÉAzÀÄ ªÀÄvÀÄÛ ¸Àj¬ÄzÉAiÉÄAzÀÄ, F ªÀÄÆ®PÀ WÉÆö¸ÀÄvÉÛãÉ. £Á£ÀÄ ¤ÃqÀ¯ÁzÀ AiÀiÁªÀÅzÉà ªÀiÁ»wAiÀÄÄ
¥ÀjÃPÉë/£ÉêÀÄPÁw ªÀÄÄAZÉ, £ÀqÉAiÀÄĪÁUÀ CxÀªÁ vÀgÀĪÁAiÀÄ ¸ÀļÀÄî CxÀªÁ vÀ¥ÉàAzÀÄ PÀAqÀÄ §AzÀ ¸ÀAzÀ¨sÀðzÀ°è CxÀªÁ C£ÀºÀðvÉ ¥ÀvÉÛAiÀiÁzÀ ¸ÀAzÀ¨sÀðzÀ°è £ÉêÀÄPÁw ¸À«ÄwAiÀÄÄ £À£Àß «gÀÄzÀÝ
¤AiÀiÁªÀiÁ£ÀĸÁgÀ PÀæªÀÄ PÉÊUÉƼÀÀÄzÀÄ JAzÀÄ £À£ÀUÉ w½¢gÀÄvÀÛzÉ.
2. £Á£ÀÄ C¢ü¸ÀÆZÀ£ÉAiÀÄ®è £ÀªÀÄÆ¢¹gÀĪÀ ¤AiÀĪÀÄ ªÀÄvÀÄÛ «¤AiÀĪÀÄUÀ¼À£ÀÄß ºÁUÀÆ J¯ÁèµÀgÀvÀÄÛUÀ¼À£ÀÄß eÁUÀgÀÆPÀvɬÄAzÀ N¢gÀÄvÉÛÃ£É ªÀÄvÀÄÛ CªÀÅUÀ½UÉ §zÀÝ£ÁVzÀÄÝ, PÀlÄÖ¤mÁÖV ¥Á°¸ÀÄvÉÛãÉAzÀÄ
WÉÆö¸ÀÄvÉÛãÉ. £Á£ÀÄ Cfð ¸À°è¹zÀ ºÀÄzÉÝAiÀÄ £ÉêÀÄPÁw ¤UÀ¢ ¥Àr¹zÀ ªÀAiÉÆëÄw, «zÁåºÀðvÉ ªÀÄÄAvÁzÀ EvÀgÉ µÀgÀvÀÄÛUÀ¼À£ÀÄß ¥ÀÆgÉʹgÀÄvÉÛãÉ. £Á£ÀÄ F ¥ÀjÃPÉëAiÀi°è ºÁdgÁUÀ®Ä F
 »AzÉ GZÁÑl¸À®ànÖ®èªÉAzÀÄ F ªÀÄÆ®PÀ WÉÆö¸ÀÄvÉÛãÉ.
3. £Á£ÀÄ F ºÀÄzÉÝAiÀÄ DAiÉÄÌAiÀÄ ¸À®ÄªÁV Cfð ¸À°è¸ÀÄwÛgÀĪÀÅzÀÄ F ºÀÄzÉÝAiÀÄ ¤AiÀĪÀÄ ªÀÄvÀÄÛ «¤AiÀĪÀÄUÀ¼À£ÀÄß M¦àPÉÆAqÀAvÉ DVgÀÄvÀÛzÉAzÀÄ £À£ÀUÉ ¸ÀA¥ÀÆtðªÁV w½¢gÀÄvÀÛzÉ.
4. £Á£ÀÄ F ºÀÄzÉÝAiÀÄ ¸À®ÄªÁV ¸À»µÀÄÚvÉ ¥ÀjÃPÉëUÉ ªÀÄvÀÄÛ zÉÊ»PÀ ¥ÀjÃPÉëUÉ £Á£ÀÄ ¸Àé EZÉѬÄAzÀ ¨sÁUÀªÀ»¸ÀÄwÛzÉÝãÉ. ºÁUÀÆ ¸ÀzÀj ¸À»µÀÄÚvÀ ªÀÄvÀÄÛ zÉÊ»PÀ ¥ÀjÃPÉëUÉ £Á£ÀÄ ¸ÀzÀÈqsÀ£ÁVgÀÄvÉÛãÉAzÀÄ
F ªÀÄÆ®PÀ ¥ÀæªÀiÁtÂÃPÀj¸ÀÄvÉÛÃ£É ºÁUÀÆ ¸À»µÀÄÚvÉ ¥ÀjÃPÉëAiÀÄ ¸ÀAzÀ¨sÀðzÀ°è ¸ÀA¨sÀ«¸ÀĪÀ AiÀiÁªÀÅzÉà jÃwAiÀÄ C£ÁºÀÄvÀ / vÉÆAzÀgÉUÀ½UÉ ¥Éưøï E¯ÁSÉ/ £ÉêÀÄPÁw ¸À«ÄwAiÀÄÄ
dªÁ¨ÁÝgÀgÁVgÀĪÀÅ¢®è. £Á£ÀÄ £À£Àß ¸ÀéAvÀ »vÀ zÀȶ׬ÄAzÀ £À£Àß zÉúÀzÀ ªÉÊzÀåQÃAiÀÄ ¥ÀjÃPÉëAiÀÄ£ÀÄß ªÀiÁr¹PÉÆAqÀÄ, DgÉÆÃUÀåªÀÅ J®è jÃw¬ÄAzÀ®Æ ¸ÀzÀÈqsÀªÁVzÉ JAzÀÄ RavÀ ¥Àr¹PÉÆAqÀÄ
E¯ÁSÉ £ÀqɸÀĪÀ ¸À»µÀÄÚvÉ ªÀÄvÀÄÛ zÉúÀzÁqsÀåðvÉ ¥ÀjÃPÉëUÉ J®è «zsÀ¢AzÀ®Æ CºÀð£ÉAzÀÄ/CºÀð¼ÉAzÀÄ ªÀÄÄAavÀªÁVAiÉÄà w½zÀÄPÉÆAqÀÄ ¨sÁUÀªÀ»¸À®Ä ¸ÀeÁÓVgÀÄvÉÛãÉAzÀÄ F ªÀÄÆ®PÀ
WÉÆö¸ÀÄvÉÛãÉ.

Applicant’s signature / CfðzÁgÀ£À ¸À»/- Applicant’s Identity Card / CfðzÁgÀ£À UÀÄgÀÄw£À

aÃn

Date : 23 September 2019 12: 3/3 IP : 157.49.184.178