-/ANNEXURE-I

t-t -ttt -tt-t tttt t STAFF SELECTION COMMISSION

t.tt.t.t., t.t`.t.t., tt.t.t. tt t.tt.t. -t (tt-tt-t tct) t t t t`-t t-tt, ze11
RECRUITMENT FOR THE POST OF CONSTABLE (GENERAL DUTY) IN CISF, CRPF, BSF & SSB, 2011
tttt tt+tt t -tt t`ctft-t-t t`ttt` ttt -t t` t t-t ztt tt ttttt-tt ttt ta -t ttt t -t t`-tt-t t t`-t -tt-t tt tt-t tt-t t -t tt rttt t t
Please read instruction in the Notice of the Examination/Brochure carefully. Use Blue or Black ball pen to write in the box

1. State / UT of Domicile tt / 1.1 State / UT Code / tt

2. tt+tt t -r tt -tt-tfName of the written Examination Centre 2.1 t-r tt f Center Code

3. --tt tt tt t t -tt-t (tt tt -t) -t t`ct-t zt-t rt-ttt t-t -t t` t -tt-t t t-ttt t t+tt -t t`-tt -tt-t t t`t-rt t tttt t tt-t t ttt t tt tt-tt ut
Candidates Full Name (in English). Write in Capital Letters exactly as in Matriculation Certificate. Leave a box blank between any two part of the name.


4. t`t-tt tt -tt-t (t t tt t t t+tt -t t`-tt) f Fathers Name (Write in Capital Letters in English)


5. -tt-tt tt -tt-t (t t tt t t t+tt -t t`-tt) / Mothers Name (Write in Capital Letters in English)


6. t--t tt -ttt t / Date of Birth

t`-t / Day -trt-t /Month tt /Year

7. t-tt / Gender
(t`-tt 1--tt t z-tt)
(Write 1-Female & 2- Male)
8. tc tt-tt /Nationality
(t`-tt 1-tt-ttt t z-t-t)
(Write 1-Indian & 2 - Others)
9. zt-t / Fee
( t`-tt 1-zt-t tt t t-tt-t t z- u c tt ttt t`ttt)
(Write 1-Fee paid & 2- Exemption claimed)
10. ~t tt / Category

(t`-tt a-t-tt,1 ttt,z tttt t e-
tt`tt)
(Write 9-General, 1-SC,2-ST, 6-OBC)
11. t tt ttt t-ttt
t t`-tt r ?
Whether Ex-serviceman ?
(t`-tt s-t-ttt tt`-tt)
(Write 3- Ex-Serviceman)
11.1. t-ttt tt` -tt t t`-t For Ex-Serviceman
ttt ttt` t / Length of Service [tt /Year]
ttt t-ttt-t t`-tt`t /Date of Discharge
t`-t/Day -trt-tfMonth tt /year)
12. t tt ttt tt-tt -t uc -ttr-t r ?
Whether seeking Age
relaxation?
(t`-tt 1-rt , z--trt) (Write -1-Yes, 2-No)
12.1 tt` rt, tt t t`t-t t
If yes, indicate code
(t ttt tt t tt--tt tt tt`t-t t)
(Write two digit numeric code)
13. ttt-t rttt-t tt tt-tt-t tt--t-t t`-tt`t (04.03.2011) tt
ttt
Age as on normal closing date (04.03.2011)

tt f Years -trt-t / Months t`-t / Days
1. t tt ttt t-tt tt r ?
Whether belong to Minority
Communities?
(t`-tt 1-rt, z--trt) ) (Write -1-Yes, 2- No)
15. t tt -t-tt f -t uc -ttr-t r ?
Whether seeking relaxation
in height / chest ?
(t`-tt 1-rt ,z--trt) (Write -1-Yes, 2-No)
15.1 ?
If yes, category under which relaxation sought?
(t`-tt 1-tttt , z-t-t ) (Write -1 for ST, 2 for
Others)
16. tt` ttt
,
If you belong to Border district ,
t ttt tt tt t t`t-t t f
Write two digit code
16.1 tt` ttt /
,
If you belong to Militancy/Naxal
affected district ,
t ttt tt tt t t`t-t tf
Write two digit code
17. t .t.t.-t t tt rtttt` -tt-tt f
Preference of post for CPOs









rttt.1 rttt.2 rttt.3 rttt.4
Pref.1 Pref.2 Pref.3 Pref.4

BSF : A
CISF : B
CRPF : C
SSB : D
18. ztt`+tt tr -tt tt
Educational qualification Code


t`ttt tt
Subject Code
ttt tt rtt` -tzt-t (%)
Percentage (%) of Marks



-ttt-t (tt tt -1, t`r-t -z t t-t-s)
Medium ( English-1, Hindi-2, Others-3)





19. ttt t-ttt tt t`ttt Details of work Experience / Govt. Service rendered
t tt tt -tt-t
Name of the Organisation(s)
t-tt-t
Designation
ttt tt t`ttt
Nature of the Duty(ies)
ttt tt ttt`t / Period of Service
t /From -tt / To




20. t-tt: tt-t -tt-t tt`r-t t-t ttrt tt tt t-tt tttt t t t+tt -t tt t`r-t -t t`-tt
Address: Write your complete Address including your Name in English Capital Letters or in
Hindi.













zz.--tttt t r-tt+t(tt-t tttc r-tt`-tt`t -t)
Signature of the Candidate in the above Box
(Only in running Hand)



















20.1 -ii ii;i i .; Mobile No. :
Email ID .





21. -iiiii-i
+ :i-ii x s :i-ii ~iiii ii
tii ti -i iiii iii -iiiii-i
iti ii .i :i i`i-iiii
(:-ii i i -iii ii
:iiii`-ii i iii )
Photograph
Paste here firmly your recent
photograph
(4 c.m.X 5c.m)
(Do not staple. Do not get the
Photograph attested)
~iisi-iii (iii iiii ii .iii i ti) Roll
Number ( for Office use only)


(1 of 2)
(Page 1 of 2)
{j BBc BE {i Postal address
ii-i Name__________________________________________________
__________________________________________________________
__________________________________________________________
___________________________________________________________
i`-ii PIN:
tttt t-tt Permanent / Domicile address
ii-i Name_________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
i`-ii PIN:









23. tt ttt fDeclaration
(i ) -ii ;:i iii i i`i ii; ~ii ~iiii -i-i iti iii t -ii it -iii-i t i`i ii` -i ;:i i`ii-i ii iii iii;iii t ii ~iiiii
ii -ii ~iiii :i:ii ii -i ~i:iiii i i`ii iiii
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 by the Commission.
(ii) -ii i`iii-i -i i i; iii ii iii-iii -i. i`iii t ~ii -i iii iii -iiii ii ii iii ii;ii t
I have read the provisions in the Notice of the examination carefully and hereby undertake to abide by
them.
(iii) -i it ii iiiii iii;iii t i`i -i ;:i -iiii -i .iii i i`i i`iiii`i ~iii :ii-ii, ii`ii iiiii ~iii` :iiii -ii-iii ii :iii
iii ii -ii iii;iii t
I further declare that I fulfill all the conditions of eligibility regarding age limits, educational qualifications
etc., prescribed for admission to the examination.
(iv) -i it ii iiiii iii;iii t i`i -ii ~iiiii i-iiii iii ~iiiii;:ii iii :iii ~iiiii ii i`i:ii ii -iiii -i ii :i iti
iii iii t iii -ii i`i:ii ii i`ii`i iiiiii ii iii ii iiii iti -iiii iii t | |, ~|| ||||| |.||/ |.|| , |`| || -||||
-||| -| |~|| ~|| |||-.| -|,| |`||| ||| , |||| ,||| -|,| ||| , |||| ||`|||| | ||-| || -||| -|||.| -|,| || | ,
I also declare that I do not stand debarred by SSC/UPSC as on date and have never been convicted by any
court of law. I also declare that no criminal case is pending against me. Further declare that I have never
been dismissed or removed from Govt. Service or my service been terminated during probation.
(v) * ~iii :ii-ii -i iiti iii is :iii i ~i:i i`ii i-iiii i i`i
-i it iiiii iii;iii t i`i -i i is :iii ii i ~i:ii`ii i-iiii t i i`iii`-ii ~iiii -i s ii ii :iii ii :iiiiii
~iii`i i:ii ii -iiii iii`:i -i i`iii i`i t, ~iiii -i-i i-ii ii ii ~ii`i-i i`ii`i ii :i:i -ii -ii i ii t
* For Central Govt. Civilian Employee seeking age relaxation.
I declare that I am a Central Govt. Civilian Employee and completed 3 years regular service or regular
length of service stipulated in the Notice of the examination on or before date of closing of submitting
application form given in the Notice.
(vi) * ~ii i`-ii ii :i :ii i`ii ~iiii i i`i
-i it ii iiiii iii;iii t i`i -i :i :i-iii :i :ii i`ii t i` i:i iii`-ii i .ii`iii i`iiii i i`iii 8.9.1993 i ii. ii.
:i. ssc:z;zz;s :ii. (:i:iii) -i i`ii`ti ~iiii i ~ii:ii iii :iii ii :iii~ii -i ~iiii i .iiiii ti i`-ii ii -iiii
iii t it ii iiiii ii iiii t i`i -i iii :iii, iii`-ii i .ii`iii i`iiii i i`ii`ii :iiiiii ii i`i iii`:i -i ii`ii
t, :ii iti -iiii iiiiii ii-ii :i. iii-i s -i iii`ii iiiiii;iii ( sii-iiii) :i :iii`ii iti t -i it ii iiiii
iii;iii t i`i -i -ii:i -iiii iii`:i -i i`iiii`i .ii-i -i ~ii i`-ii ii ii .i-iii -i-i t
*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 in Deptt. 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 the schedule of the OM mentioned above and
modified vide Govt. of India DOPT OMs mentioned in the Notice. I further declare that I am in possession
of OBC Certificate in the prescribed format given in the Notice of the examination.
(vii) ii-ii :i i`iii i i`i
-i iiiii iii;iii t i`i -i -iiii i`iii -i i ~ii:ii ii-ii :i i`ii :ii-iiii -ii-iii ii :iii iii ii -ii iii;iii t
For Candidate belonging Ex-Serviceman
I declare that I fulfill all the eligibility condition relating to Ex-Serviceman as per notice of examination.
(viii) -i i ii iiiii iii;iii t i`i ;:i ~iiii -i-i -i i` i :iii i`iii -ii ~ii`iii-i iiiiii ~ii i`iii:i i ~ii:ii :ii,
-ii i :iti t -i :i-iiii;:i-iiii t i`i -iiii :i -iti ii ii -i ii; ii :iiii -ii; t;;ii ii ~i:ii -ii; iii -i ii
~i-ii-iii ii -iii iii -i -ii ~iii`iii;i`iiiii i`i:i ii ii :iiii t
I hereby declare that all statements made in this application are true, complete and correct to the best of my
knowledge and belief. I understand that in the event of any information being found suppressed/false or
incorrect or ineligibility being detected before or after the examination, my candidature/appointment is
liable to be cancelled.


:iii;Place: ..
D D M M Y Y
iiii;Date:



* ii` iii i ti ii it ii; i ii
* Strike off this sentence if not applicable
--iiii i t:iii (iii i:ii t:ii`ii`-i -i)
Signature of candidate ( only in running hand)





~it:iiii`i ~iiii -i-i ii i i`ii iiiii
Unsigned application will be rejected

(Page 2 of 2)


z+. i . i. ii i`i i i`i
:iii
Space for CRF Stamp
r 50.00 ii i . i.
ii i`i iti ii .i
:i i`i-iii iii iii :i
ii iti :i it
iii iii t
(:-ii i i )

Paste here firmly CRF
Stamp of r 50.00
denomination and get
it cancelled from the
post office where
purchased.
( Do not Staple)
i. i. ii i`i i`i-iiii
i ii iii ii i`ii
iii iii i`i ti :iii
Space for cancellation
stamp aby post office
after affixing CRF
stamp

Annexure II

BROCHURE

INSTRUCTIONS FOR FILLING UP THE APPLICATION

1.0 Please read the instructions given in the Notice of Examination carefully before filling up the application
form, in your own interest.

2.0 Use only blue/black ball pen to write in the boxes. i.e.

3.0 Instructions have been given for most items in the application itself which should be gone through carefully
before filling up the boxes. For items for which instructions are not available, further instructions given
below may be gone through carefully.

4.0 Please go through the instructions given below for filling up each item numbered in the application form:-

Column 1 and 1.1: State / UT of Domicile : For name and Code, see Annexure XII.
Domicile certificate will be required as proof, to be produced at the time of PST/PET or
Written or Medical Examination.

Column 2 and 2.1: Name of the Examination Centre and Code
Refer to para-7 of the Notice of the Examination.
It may be noted that the application should be sent to the Regional Office in whose
jurisdiction the centre is situated, irrespective of State/UT of Domicile.

Column 12.1: Code for seeking age relaxation.
Refer to para 4 B of the Notice of the Examination.

Column 14: Candidates may indicate whether they belong to one of the minority communities notified by Govt.
namely, Muslims, Christians, Sikhs, Buddhists or Zoroastrians (Parsees).

Column 15: Refer to Para 8 I(iii) of the Notice of the examination.

Column 16 and 16.1: For Code for Border Districts & Militancy/ Naxal affected area, please see Annexure XIII and
Annexure XIV respectively.

Column 17: Preference for Posts

Candidates should carefully indicate preference for CPOs. Option once exercised will be final and
no change will be allowed under any circumstances.

Column 18: Educational Qualification from Matriculation or Equivalent onwards:
See Annexure X for Codes. Use OTHERS (Code No.35 ) for any other qualification.

Column 19: Subject Code :See Annexure - XI for codes. Use OTHERS (Code No.48) for other subjects.

Column 20: Postal Address

Write your complete communication address including your Name in English in capital
letters or in Hindi with blue/black ball pen. Do not forget to write 6 digits PIN Code in the
boxes. All the correspondence will be made to this address.

Column 20: Permanent/ Domicile Address

Write your complete permanent address including your Name in English in capital letters or
in Hindi with blue/black ball pen. Do not forget to write 6 digits PIN Code in the boxes.

Column 21: Photograph

Paste your recent photograph of size 4cmx5cm. Do not staple and do not get the photo
attested. Please note that your application shall be rejected summarily without photograph
or with mutilated / defaced photograph.

Box in the Application form for Roll Number to be left unfilled (blank) by the candidate.

Column 22 & 23: Signature of Candidate (Wherever required)
Please sign in running hand. Signature in capital letters of English shall not be accepted
and your application shall be summarily rejected. Unsigned application shall also be
rejected.

IMPORTANT:- It is in the interest of the candidates to furnish e-mail ID and /or mobile number to enable the
Commission at its option, to send the call letter / inform about venues for PST/PET or
Written Examination or Medical Examination.