GOVERNMENT OF PUDUCHERRY APPLICATION NUMBER

POLICE DEPARTMENT
APPLICATION FOR RECRUITMENT TO THE
POST OF SUB-INSPECTOR OF POLICE

IMPORTANT INSTRUCTIONS 10. WHETHER RESIDENT OF UNION 14. HAVE YOU EVER BEEN INVOLVED
TERRITORY OF PUDUCHERRY IN CRIMINAL CASE
1) Before filling the application read the
instructions furnished in the Website YES YES
/ News Paper and overleaf. NO NO
2) Do not use photocopy of this form.
3) Erase completely to change the
11. EDUCATIONAL QUALIFICATION 15. HAVE YOU EVER BEEN ARRESTED
responses.
4) Do not make any stray marks on this GRADUATE YES
sheet. NO
5) Please do not staple or meddle or POST GRADUATE
fold at any other place than 16. LIST OF ENCLOSURES (COPIES)
prescribed in the Application.
12. ADDITIONAL QUALIFICATION
6) Keep a photo copy of completed BIRTH CERTIFICATE
OMR/ICR application with you. NCC
7) Use blue or black ink ball point pen to TERRITORIAL ARMY COMMUNITY CERTIFICATE
darken the relevant circles fully CERTIFICATE IN COMPUTER APPLICATIONS
without making any holes. SPORTS NATIVITY & RESIDENCE CERTIFICATE
OTHERS
MARK COMPLETELY AS
EDUCATIONAL QUALIFICATION CERTIFICATE
INDICATED BELOW
CORRECT 13. WHETHER EX-SERVICEMAN
SERVICE CERTIFICATE
/ YES
WRONG NO EMPLOYMENT EXCHANGE CARD

E MAIL ID:

PHONE/ MOBILE NUMBER:

Please fold here

2. DATE OF BIRTH
1. NAME OF THE APPLICANT DAY MONTH YEAR

A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 0 0 0 0 0
B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B 1 1 1 1 1
C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C 2 2 2 2
D D D D D D D D D D D D D D D D D D D D D D D D D D D D D D 3 3 3 3
E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E 4 4 4
F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F 5 5 5 5
G G G G G G G G G G G G G G G G G G G G G G G G G G G G G G 6 6 6 6
H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H 7 7 7 7
I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 8 8 8 8
J J J J J J J J J J J J J J J J J J J J J J J J J J J J J J 9 9 9 9
K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K
L L L L L L L L L L L L L L L L L L L L L L L L L L L L L L
M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M
3. SEX
N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N
O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O MALE
P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P FEMALE
Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q
R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R
S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S
4. CATEGORY
T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T
U U U U U U U U U U U U U U U U U U U U U U U U U U U U U U GENERAL
V V V V V V V V V V V V V V V V V V V V V V V V V V V V V V ORIGIN MIGRANT
W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W SC
X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X BT
Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y MBC
Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z OBC

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5. FATHER'S NAME

6. EMPLOYMENT EXCHANGE REGISTRATION NUMBER 6a. EMPLOYMENT REGISTRATION DATE

DAY MONTH YEAR

7. PHOTOGRAPH 8. PERMANENT RESIDENTIAL ADDRESS (USE CAPITAL LETTERS IN ENGLISH)

Paste here firmly PINCODE:

your recent color
photograph (4 cm X 5 cm) 9. PRESENT POSTAL ADDRESS (USE CAPITAL LETTERS IN ENGLISH)

PINCODE:

DECLARATION
I do hereby affirm that the information furnished by me above is true and correct to the best of my knowledge and belief. My application
is liable for rejection at any stage if any information furnished by me is found to be false.

Place :_____________________________
D D M M Y Y Y Y
Date : SIGNATURE OF THE CANDIDATE
 INSTRUCTIONS FOR FILLING UP THE APPLICATION FORM
COLUMN 1 : NAME OF THE APPLICANT COLUMN 7 : PHOTOGRAPH
Write your name legibly in CAPITAL letters as given in the records of Affix your latest passport color photograph of size 4.0 x 5.0 cm on the application
Matriculation or equivalent certificate. One box should be left blank between two form at the place provided.
parts of the name as shown in the example below. In case the name is long and
cannot be accommodated within 30 boxes, abbreviate the name in such a way
as to accommodate within 30 boxes and darken the corresponding lettered COLUMN 8&9 : PERMANENT RESIDENTIAL & PRESENT ADDRESS
circles below the boxes.
Write the complete and correct permanent residential and present
M S R I KA N T H AN postal address in CAPITAL letters in the blocks provided. Write the
PINCODE number without fail. Communication will be made on present
A A A A A A A A A A A A A A A A A A A A A
postal address.
B B B B B B B B B B B B B B B B B B B B B

C C C C C C C C C C C C C C C C C C C C C 8. PERMANENT RESIDENTIAL ADDRESS (USE BLOCK LETTERS IN ENGLISH)

D D D D D D D D D D D D D D D D D D D D D M SR I K AN TH AN
E E E E E E E E E E E E E E E E E E E E E 3 8 D UMAS S T R E E T DOOR NO : 1 1 2
F F F F F F F F F F F F F F F F F F F F F P UDUC H ERRY
G G G G G G G G G G G G G G G G G G G G G

H H H H H H H H H H H H H H H H H H H H H PINCODE: 6 0 5 0 01
I I I I I I I I I I I I I I I I I I I I
9. PRESENT POSTAL ADDRESS (USE BLOCK LETTERS IN ENGLISH)
J J J J J J J J J J J J J J J J J J J J J

K K K K K K K K K K K K K K K K K K K K K
M SR I K AN TH AN
L L L L L L L L L L L L L L L L L L L L L
3 8 D UMAS S T R E E T DOOR NO : 1 1 2
M M M M M M M M M M M M M M M M M M M M M
P UDUC H ERRY
N N N N N N N N N N N N N N N N N N N N N
PINCODE: 6 0 5 0 01
O O O O O O O O O O O O O O O O O O O O O

P P P P P P P P P P P P P P P P P P P P P

Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q
COLUMN 10 : WHETHER RESIDENT OF UNION TERRITORY OF PUDUCHERRY
R R R R R R R R R R R R R R R R R R R R R
Select the applicable circle and darken the 10. WHETHER RESIDENT OF UNION
S S S S S S S S S S S S S S S S S S S S S same. Example shown for resident of TERRITORY OF PUDUCHERRY
T T T T T T T T T T T T T T T T T T T T T Puducherry. YES
U U U U U U U U U U U U U U U U U U U U U NO
V V V V V V V V V V V V V V V V V V V V V

W W W W W W W W W W W W W W W W W W W W W

X X X X X X X X X X X X X X X X X X X X X
COLUMN 11 : EDUCATIONAL QUALIFICATION
Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y
Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Select your highest educational qualification 11. EDUCATIONAL QUALIFICATION
and darken the corresponding circle fully. GRADUATE
Example shown for a graduate. POST GRADUATE
COLUMN 2 : DATE OF BIRTH 2. DATE OF BIRTH
Write the date, month and year of birth as per Day Month Year
English Calendar and as recorded in
Matriculation or equivalent certificate and darken 1 9 0 2 8 8
the corresponding circles. 0 0 0 0 0 COLUMN 12 : ADDITIONAL QUALIFICATION
Example:19th February1988 should be marked 1 1 1 1
Select the additional qualification 12. ADDITIONAL QUALIFICATION
as shown here. 2 2 2 2 you possess from the list given NCC
3 3 3 3 here and darken the corresponding TERRITORIAL ARMY
4 4 4 circle/s as shown here.
CERTIFICATE IN COMPUTER APPLICATIONS
5 5 5 5
SPORTS
6 6 6 6
OTHERS
7 7 7 7

8 8 8 8

9 9 9 9
COLUMN 13 : WHETHER EX-SERVICEMAN
Confirm whether you are an Ex-serviceman or not by darkening the relevant
COLUMN 3 : SEX circle fully as shown here.
3. SEX 13. WHETHER EX-SERVICEMAN
Darken the applicable circle fully.
MALE
Example shown for Male. YES
FEMALE
NO

COLUMN 4 : CATEGORY
4. CATEGORY
Darken the applicable circle fully.
Example shown for BT category. GENERAL
ORIGIN MIGRANT COLUMN 14 : HAVE YOU EVER BEEN INVOLVED IN CRIMINAL CASE
SC
BT
Select the relevant circle and darken the 14. HAVE YOU EVER BEEN INVOLVED
IN CRIMINAL CASE
same as shown here.
MBC YES
OBC NO

COLUMN 5 : FATHER'S NAME

Write your father's name legibly in CAPITAL letters as given in the records
of Matriculation or equivalent certificate. One box should be left blank
between two parts of the name as shown in the example below. In case COLUMN 15 : HAVE YOU EVER BEEN ARRESTED 15. HAVE YOU EVER
the name is long and cannot be accommodated within 30 boxes, abbreviate the Select the relevant circle and darken the same as BEEN ARRESTED
name in such a way as to accommodate within 30 boxes. shown here. YES
5. FATHER'S NAME NO

M R A MA R A J A N
COLUMN 16 : LIST OF ENCLOSURES
COLUMN 6 : EMPLOYMENT EXCHANGE REGISTRATION NUMBER
Select the enclosures from the 16. LIST OF ENCLOSURES (COPIES)
Write your employment exchange registration number as mentioned in your list provided here and darken BIRTH CERTIFICATE
registration card in the boxes provided legibly. Example: 0001214 the corresponding circles fully COMMUNITY CERTIFICATE
6. EMPLOYMENT EXCHANGE REGISTRATION NUMBER as indicated.
NATIVITY & RESIDENCE CERTIFICATE
EDUCATIONAL QUALIFICATION
0 0 0 1 2 1 4 CERTIFICATE
SERVICE CERTIFICATE
EMPLOYMENT EXCHANGE CARD
COLUMN 6(a) : EMPLOYMENT REGISTRATION DATE
Write your employment exchange registration date as mentioned in your
registration card in the boxes provided legibly. Example:21st October 2008
SIGNATURE OF THE CANDIDATE:
should be marked as below.
Candidate should affix signature with
6a. EMPLOYMENT REGISTRATION DATE in the box provided in running hand.
SIGNATURE OF THE CANDIDATE
Unsigned application will not be
DAY 2 1 MONTH 1 0 YEAR 0 8 accepted.