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Wbcs 2011 Application Form

Wbcs 2011 Application Form

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Published by: subhajit_pal on Sep 09, 2010
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07/27/2011

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Page 1 of 3
PUBLIC SERVICE COMMISSION, WEST BENGALAPPLICATION FORM
West Bengal Civil Service (Executive) Etc. Examination, 2011
ADVERTISEMENT NO.08/2010Closing date for receipt of Application : The 14
th
September, 2010.
CAUTION
(i) A candidate must consult the “
Important Information
”, “
Scheme and Syllabus
” available with advertisement in the Commission’sWebsite, then use the prescribed application format and fill in the application form correctly against all the items in his/her ownhandwriting with ball point pen of black/blue ink and furnish required particulars/documents. If any item(s) of the application isconsidered inapplicable to the candidate he/she should write ‘
NOT APPLICABLE
 
or (N.A.)’
against the particular item(s) and in anycase
no item of the application should remain unfilled.
(ii) Correction/overwriting, if any, should be accompanied by signature of the candidate.(iii)
In case the application is not filled in accordance with the above instructions or any of the required documents is not enclosed, it will be treated as incomplete/defective and summarily rejected 
.
Note :
 
Keeping the application form in front, the particulars/documents are to be stitched with the application securely with a durable thread in the following sequence – (1) I.P.O. or Treasury Challan, in original (not required for SC/ST candidates of W.B. and Persons with Disability), attested or self- certified photocopies of (2) Madhyamik or equivalent qualification certificate, (3) Bachelor Degree certificate (4 ) SC/ST/BC/PH certificate (if applicable), (5) Citizenship certificate (for candidates acquiring citizenship by registration) and (6) Two Unstamped Self-addressed envelopes. 
1.
(a) I.P.O./Treasury Challan attached for
:
Rs. _____________________ (b) I.P.O. No.(s) & Value
:
(c) Date of purchase and name of issuing
:
Post Office with address(d) Treasury Challan No. & Date
:
 
2.
Name in Full
:
 (IN CAPITAL LETTERS)
3.
Choice of Preliminary Examination Centre
:
 
Name of Centre
 
*
 
(Consult list of Examination Centres at the end of the form)[ candidates suffering from blindness or low vision requiringthe help of a Scribe should opt Kolkata (South) Centre only ]
4.
(a) Community / Category
:
Gen BC SC ST PWD
(Person with disability)
 [ Put
 
’ mark in appropriate box(s) ](b) Whether SC/ST/BC Certificate obtained
:
Yes Nofrom competent authority of West Bengal :[ Put
 
’ mark in appropriate box(s) ](c) If SC/ST/BC Candidate, mention
:
Sub-Caste StateIssuing Authority
 
Roll No.
(Space for office use only)
Space for pasting ofrecent passport sizephotograph of thecandidate with his/herfull signature thereon.
 
Page 2 of 3
(d) (i) In case you are a person with disability (PWD), state the Category (Put
’ mark in the appropriate box) :Suffering from blindness or low vision Hearing Impaired Orthopaedically Handicapped(ii) In case you are a person with blindness or low vision, mention if you require the help of a Scribe : Yes No
 
(Put ‘
’ mark in appropriate box)
5.
Sex (Put
’ mark in appropriate box)
:
Male FemaleD D M M Y E A R
 
6.
(a) Date of Birth (as recorded in Madhyamik or equivalent
:
 examination Certificate)(b) Place of Birth (including District & State)
:
_____________________________________ 
7.
(a) Whether a Citizen of India
:
Yes No(Put ‘
’ mark in appropriate box)(b) Whether a natural citizen or citizen by registration ?
:
Natural citizen Citizen by Registration(Put ‘
’ mark in appropriate box)[ If a citizen by registration, attach attested orself-certified photo copy of the certificate]
8.
Father’s Name
:
 (IN CAPITAL LETTERS)
9.
(a) Complete address for communication
:
 (IN CAPITAL LETTERS) mentioning locality,Post office, Sub-Divn., Dist. and Pin-Code :(b) Permanent Address
:
10. Educational Qualification (Madhyamik and onwards)
:
[ Attested or self-certified photo copies of all certificates must be attached to the application]Name of ExaminationYear ofpassingBoard/University Subjects takenDivision/ Class11. Mark (with
’) your choice of language in
:
Bengali Hindi Urdu NepaliCompulsory Paper – I12. (a) Do you have the ability to read, write and
:
 speak in Bengali (Write ‘Yes’ or ‘No’)(b) Whether you are a Nepali Speaking person
:
(Write ‘Yes’ or ‘No’)(c) i) Whether you are a person from Hill areas
:
 of Darjeeling District (Write ‘Yes’ or ‘No’)ii) If yes, mention the name of Sub-division
:
 ______________________________ 
 
(d) State your mother tongue
:
 

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