**

CENTRAL RESERVE POLICE FORCE

PARAMEDICAL STAFF EXAMINATION 2020

DETAILS TO BE FILLED IN BLOCK LETTERS ONLY

* **** ******* ***

Paste latest

passport size

colour photograph

* *********** ****re Choices 1

2

3 Name of Applicant

4 Father’s Name

5 Mother’s Name

6 Date of Birth

7 Gender- Male/Female

8 Mobile Number

9 E-Mail ID

10 Category: Unreserved

/SC/ST/OBC/EWS

11 Religion

12 Whether Govt. Employee- Yes/No

13 Name of Employer

14 Marital Status- Married/Un-Married

15 Nationality- Indian/Others

16 State/UT (Domicile)

17 Name of the particular area or

region for claiming extended time

18 Height (in Cms)

19 Chest (Not applicable for female

candidates)

Expanded Un-expanded

20 Whether seeking Height Relaxation Yes/No

21 Whether seeking Age Relaxation Yes/No

a) As depended family members

of persons killed in Riots of

1984.

b) As depended family members

of persons killed in Riots of

2002 in Gujarat.

c) Persons originally domiciled

in J&K during 01/01/80 to

31/12/89.

22 Whether Ex-Serviceman Yes/No

a) Date of joining service

b) Date of Discharge

c) Length of Service –

Day/Month/Year

28

23 Educational

Qualification

Education

Standard

Year of

passing

Name of School/

College

Name of Board/

University

Serial NO. of Certificate

10th

12th

Graduation

Post

Graduation

24 Technical

Qualification and

experience

25 Postal Address for

Correspondence

26 Permanent Address

27 Aadhaar Card Number (Optional)

28 Whether convicted in any criminal

or Civil case.

Yes/No

29 Whether any FIR lodged in any

Police Station.

Yes/No

30 Whether arrested by Police Yes/No

31 Whether any criminal case pending

in any court of Law.

Yes/No

32 Details of fee paid (if applicable) IPO/BD No. Date Amount 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.

SIGNATURE OF CANDIDATE

(Unsigned application will be rejected)

29

DECLARATION

i) 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 Department. 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 fulfil all the conditions of eligibility regarding age limits, educational qualifications etc., prescribed for admission to the examination. iv) I also declare that I do not stand debarred by CRPF 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) For Central Govt. Employees seeking age relaxation. I declare that I am a Central Govt. Civilian Employee and completed 03 years regular service or regular length of service stipulated in Rules & Notice of the examination on or before date of closing of submitting application from given in the Notice.

vi) 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 08.09.1993. 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 examinations. vii) For Candidates belonging Ex-Serviceman.

I declare that I fulfil all the eligibility condition relating to Ex-Serviceman as per Rule & Notice of examination.

viii) “I Son/Daughter of Shri Age years, resident of District State hereby declare that the information given above and in the enclosed documents is true to the best of my knowledge and belief and nothing has been concealed therein. I am well aware of the fact that if the information given by me is proved/not true, I will have to face the consequences as per the Law. Also, all the benefits availed by me shall be summarily withdrawn”.

Signature of candidate

Place

Date

Unsigned Declaration will be rejected.

30

APPENDIX- A-I

Form of Certificate for serving Defence Personnel

I hereby certify that, according to the information available with me,

(No.) Rank) Name)

is due to complete the specified term of his engagement with the Armed Forces on the

(Date)

Place :

Date: Signature of Commanding Officer

with office seal

31

APPENDIX- A-2

UNDERTAKING TO BE GIVEN BY THE EX-SERVICEMAN (ESM) I understand that, if selected on the basis of the recruitment/examination to which the application relates, my appointment will be subject to my producing documentary evidence to the satisfaction of the Appointing Authority that I have been duly released/retired/discharged from the Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Re-employment in Central Civil Services and Posts rules, 1979, as amended from time to time). I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex- Servicemen in regard to the recruitment covered by this examination, if I have at any time prior to such appointment, secured any employment on the civil side (including Public Sector Undertakings, Autonomous Bodies/Statutory Bodies, Nationalized Banks, etc.) by availing of the concession of reservation of vacancies admissible to Ex-Servicemen, except as per Department of Personnel and Training OM No.36034/1/2014- Estt(Res) dated 14.8.2014.

I further submit the following information:

a) Date of appointment in Armed Forces

b) Date of discharge

c) Length of service in Armed Forces

d) My last Unit / Corps

Place:

Date: (Signature of the Candidate)

32

APPENDIX B

FORM OF SC/ST CASTE CERTIFICATE

This is to certify that Shri/Smt/Kumari son/daughter of of village/town in District/Division of the State / Union Territory belongs to the ……. Caste/Tribe which is recognized as a scheduled caste / scheduled tribe under:-

• The constitution (Scheduled Castes) order, 1950

• The constitution (Scheduled Tribe) order, 1950

• The constitution (Scheduled Castes) (UT) order, 1951

• The constitution (ST) (UT) order, 1951

• (As amended by the Scheduled Castes and scheduled tribes lists (Modification Order) 1956, the Bombay reorganization Act 1960, the Punjab, Recognization Act, 1966. The State of HP Act,1970, the North-Eastern area (recognisation) Act, 1971 and the scheduled caste and scheduled tribes

(amendment) Act, 1976.

• The constitution (Jammu & Kashmir) Scheduled Castes order, 1956

• The constitution (Andaman &Nicobar Inlands) Scheduled Tribes order, 1959, as amended by the Scheduled castes and scheduled tribes orders (Amendment) Act 1976

• The constitution (Dadar& Nagar Naveli) Scheduled Tribes order, 1962

• The constitution (Dadar& Nagar Naveli) Scheduled Castes Act 1962

• The constitution (Pondicherry) Scheduled Castes order, 1964

• The constitution (Uttar Pradesh) ST order, 1967

• The constitution (Goa, Daman and Diu) SC order, 1968

• The constitution (Goa, Daman and Diu) ST order, 1968

• The constitution (Nagaland) ST order, 1970

• The constitution (Sikkim) SC order, 1978

• The constitution (Sikkim) ST order, 1978

• The constitution (J&K) ST order, 1989

• The constitution (SC) orders (Amendment) Act 1990

• The constitution (ST) orders (Amendment) Act 1991

• The constitution (ST) orders second (Amendment) Act 1991

• The constitution (ST) orders (Amendment) Ordinance 1996 2. This certificate is issued on the basis of the schedule castes / scheduled tribes certificates issued to Shri/Smt father/mother of Shri/Smt/Kumari of the village/town in District /Division of the state/UT who belong to the

caste/tribe which is recognized as a Scheduled Caste/Scheduled Tribe in the state/UT issued by the dated

3. Shri/Smt/Kumari and/or his/her family ordinarily reside (s) in village/town of District / Division of the state/UT of Place:

Date:

Signature

Designation

(with seal of office)

(Note: The term “Ordinarily resides” used here will have the same meaning as in section 20 of the Representation of the peoples Act, 1950)

33

AUTHORITIES EMPOWERED TO ISSUE CASTE CERTIFICATES

(G.I Deptt. or Pers. &Trg. O.M.No.36012/6/88-Estt(SCT), SRD-III) dated 24/4/1990) The under mentioned authorities have been empowered to issue caste certificate of verification:- 1. District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/ Addl.Deputy Commissioner/ Deputy Collector/Ist Class Stipendiary Magistrate/ Sub-DM/ Taluk Magistrate/ Executive Magistrate/Extra Assistant Commissioner. 2. Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate. 3. Revenue Officer not below the rank of Tehsildar 4. Sub-Divisional Officer of the area where the candidate and/or his family normally resides. 34

APPENDIX C

FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES (OBC) APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA

(G.I., Dept. of per &Trg OM No. 36033/28/94-Estt (Res) dated 2/7/97) This is to certify that son/daughter of of village District / Division In the state belongs to the community which is recognized as a Backward Class under:

*i) Government of India, Ministry of Welfare, Resolution No. 12011/68/93-BCC(c), dated the 10th September, 1993, published in the Gazette of India, Extraordinary, Part-I, section I No. 186, dated the 13th September,1993.

*ii) Government of India, Ministry of Welfare, Resolution No. 12011/9/94-BCC dated the 19th October, 1994, published in the Gazette of India, Extraordinary, Part-I, section I No. 163, dated the 20th October 1994.

*iii) Government of India, Ministry of Welfare, Resolution No. 12011/7/95-BCC, dated the 24th May, 1995, published in the Gazette of India, Extraordinary, Part-I, section I No. 88, dated the 25th May 1995.

*iv) Government of India, Ministry of Welfare, Resolution No. 12011/44/96-BCC, dated the 6th December, 1996, published in the Gazette of India, Extraordinary, Part-I, section I No. 210, dated the 11th December 1996.

Shri and/or his family ordinarily reside(s) in the District / Division of the State. This is also to certify that he/she does not belong to the persons/sections (Creamy Layer) mentioned in column 3 of the Schedule to the Govt. of India, Dept. of Personnel and Training O.M No. 36012/22/93-Estt(SCT) dated 8/9/1993.

Date:

Place:

District Magistrate

Deputy Commissioner etc.

Strike out whichever is not applicable.

NB:

a) The term “Ordinarily” used here will have the same meaning as in section 20 of the representation of the people Act 1950)

b) The authorities competent to issue caste certificate as indicated below:- i) District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/ Addl.Deputy Commissioner/ Deputy Collector/Ist Class Stipendiary Magistrate/ Sub-DM/ Taluk Magistrate/ Executive Magistrate/Extra Assistant Commissioner (not below the rank of First Class Stipendary Magistrate)

ii) Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate. iii) Revenue Officer not below the rank of Tehsildar and iv) Sub-Divisional Officer of the area where the candidate and/or his family normally resides. 35

APPENDIX C-1

DECLARATION BY OBC CANDIDATE REGARDING

NON-CREAMY LAYER STATUS

“I, son/daughter of Shri resident of village/town/city district State hereby declare that I belong to the community which is recognized as a backward class by the Government of India for the purpose of reservation in services as per orders contained in DOP&T OM No.36012/22/93- Estt.(SCT) dated 8/9/93. It is also declared that I do not belong to persons/sections (Creamy Layer) mentioned in column-3 of the Schedule to the above referred Office Memorandum dated 8-9-1993” Signature of applicant (OBC Candidate)

36

APPENDIX – D

FORM OF CERTIFICATE TO BE SUBMITTED BY THE CANDIDATES THOSE WHO INTEND TO AVAIL RELAXATION IN HEIGHT OR CHEST MEASUREMENT

Certified that Shri S/O Shri is permanent resident of village Tehsil/Taluka District of State.

2. It is further certified that:

*Residents of entire area mentioned above are considered as (Garhwal,Kumaouni, Dogras,Marathas, Sikkimies) for relaxation in height and chest measurement for recruitment in the Para Military forces of the Union of India.

*He belongs to Himachal Pradesh/Leh&Laddakh/Kashmir Valley/North Eastern States and is considered for relaxation in height and chest measurement for recruitment in the Para Military forces of Union of India.

*He belongs to Tribals/Adivasis Community and is considered for relaxation in height and chest measurement for recruitment in the Para military forces of the Union of India. Date:

Place:

Signature District Magistrate/

Sub Divisional Magistrate/Tehsildar

* Delete whichever is not applicable.

37

APPENDIX- E

FORM OF CERTIFICATE TO BE SUBMITTED BY CENTRAL GOVERNMENT CIVILIAN EMPLOYEES SEEKING AGE-RELAXATION

(To be filled by the Head of the Office or Department in which the candidate is working). It is certified that *Shri/Smt./Km. is a Central Government civilian employee holding post of in the pay scale of Rs. with 3 years regular service in the grade. There is no objection to his/ her appearing for the Recruitment of

Examination, 2020.

Signature

Name

Office seal

Place:

Date :

(*Please delete the words which are not applicable.) 38

APPENDIX- F

FORM OF CERTIFICATE TO BE SUBMITTED BY(DEPARTMENTAL CANDIDATES)

( TO BE FILLED BY THE HEAD OF THE OFFICE )

Certified that as per entries made in the Service Book, No. Rank Name who was appointed in the on in the rank of is continuously serving in the and has completed three years regular service. It is also certified that he has completed the period of probation satisfactorily on . He is presently posted in this unit (name of the unit). During his service he has been awarded major punishments and minor punishments. Signature of Head of Office

Name

with office Seal

39

APPENDIX- G

Government of

(Name & Address of the authority issuing the certificate) INCOME & ASSEST CERTIFICATE TO BE PRODUCED BY ECONOMICALLY WEAKER SECTIONS Certificate NO Date VALID FOR THE YEAR

This is to certify that Shri/Smt/Kumari son/ daughter/ wife of permanent resident of village/street post office

District in the State/Union Territory Pin code whose photograph is attested below belongs to Economically Weaker Sections, since the gross annual income* of his/her family ** is below Rs.8 lakh (Rupees Eight lakh only) for the financial year His/her family does not own or possess any of the following assets I. 5 acres of agricultural land and above;

II. Residential flat of 1000 sq.ft. and above;

III. Residential plot of 100 sq. Yards and above in notified municipalities. IV. Residential plot of 200 sq. Yards and above in areas other than the notified municipalities.

2. Shri/Smt./Kumari belongs to the caste which is not recognized as a Scheduled Caste, Scheduled Tribe and Other Backward Classes (Central List). Signature with seal of Office Name Designation

*Note1: Income covered all sources i.e. salary, agriculture, business, profession, etc.

**Note2: The term “Family” for this purpose include the person who seeks benefit of reservation, his/her parents and siblings belong the age of 18 years as also his/her spouse and children below the age of 18 years

***Note 3: The property held by a “Family” in different locations or different places/ cities have been clubbed while applying the land or property holding test to determine EWS status. Recent Passport size

attested photograph of the

applicant

davp 19140/11/0001/2021

Contact this candidate