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U P S C: Nion Ublic Ervice Ommission
U P S C: Nion Ublic Ervice Ommission
CHECK LIST
VERIFY THE FOLLOWING BEFORE MAILING THE APPLICATION
1. That the Application is sent as per the prescribed format given in the Employment News. It can also be downloaded from Commission's
Website : www.upsc.gov.in
2. That all the columns in Part-I and Part -II of the Application form have been filled Strictly according to the “Instructions to the Candidates”
published in the Employment News or Commission’s website.
3. That no column is wrongly filled or kept blank as the information furnished therein would be used to determine the eligibility of a candidate to
be called for interviews.
4. That all the qualifications and experiences in the relevant field( over and above the minimum qualifications and experiences prescribed) are
mentioned in the Application as the Commission may restrict the number of candidates to a reasonable limit by considering higher qualifications
and / or experiences.
5. That copies of certificates are attached in support of claims made/information given in the Application regarding Date of Birth, Degree
Certificates (along with mark sheets), Experiences, etc. Any information contained in the attached certificates shall not be considered
unless it is claimed in the application form.
6. That if the qualification possessed by the candidate is equivalent, a copy of order / letter under which it has been so treated may be
enclosed.
7. That Experience certificate(s) are as per instructions contained in Para- 7(iv) of “Instruction to Candidates”.
8. That Fee amount is Rs.50/- payable through Central Recruitment Stamp (CRFS) only. No other mode of payment is acceptable. Ensure that
CRPF is pasted in the Form and the same has been cancelled by the Post Office.
9. That SC/ST/OBC/PH/Ex-Servicemen certificate is in prescribed format as given in the Employment News. All the prescribed proforma may
also be downloaded from the Commission’s website.
10. That Government Servant certificate for seeking age relaxation has been issued after the date of publication of advertisement.
11. That Application is sent well in advance so as to reach the Commission’s Office on or before the closing date for receipt of applications.
12. That candidates are requested to super scribe the words ‘Recruitment By Selection’ on the top of the envelope while sending the Application
Form. For each application, separate envelope should be used
13. That the Application is to be sent to the Joint Secretary (Recruitment), Union Public Service Commission, Dholpur House, Shahjahan Road,
New Delhi – 110069.
IMPORTANT
1. MOBILE PHONES ARE BANNED IN THE CAMPUS OF UPSC EXAMINATION HALL
2. Government strives to have work force which reflects gender balance and women candidates are encouraged to apply
3. For any query, visit the Commission's Facilitation Centre or Dial No. 23385271
3. Citizenship :
4. Father’s Name %
7. All Educational/other professional Qualifications/Training Courses etc, (Starting from EQ (i) onwards)/Degree Examination onwards.
Level Exam passed/ Division/Grade Year of Duration of the Board/ Subject Subject of
Degree Trg. % of Marks Passing Degree/Diploma Univ. Specialisation
Office/Instt. Post held Part time/Contract Exact dates to be given Total Period (in years) Scale Nature
Firm Basis/Ad-hoc/regular/ (indicate day, month & year) of of duties
Temp./pmt. From To Years Months Days pay
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10. Date of completion of compulsory rotating internship -----------------------------------------------------------------------------------
(To be filled in case of Medical posts only)
2) -----------------------------------------------------------------------------------------------------------
3) -----------------------------------------------------------------------------------------------------------
I hereby declare that all the statements made in this applications are true and complete to the best of my knowledge and belief. I understand that action can be taken against me
by the Commission if I am declared by them to be guilty of any type of misconduct mentioned herein. I have informed my Head Office/Deptt. in writing that I am applying for this
selection.
Place :
Date : Signature of the candidate
Name _________________________
Cont. on page 53
Employment News 19 February - 4 March 2011 UPSC 53
Cont. from page 51 village/town*______________ of* ________________ District/Division*
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD _________________of the State/Union Territory* of ___________.
CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE
Signature___________________
GOVERNMENT OF INDIA
This is to certify that .......................................................................... S/o ............................. of **Designation________________
Village ................................ District/Division* ........................... in the ............................ State (with seal of office)
belongs to the ........................... Community which is recognised as Backward Class under:- State/Union Territory**
(i) Government of India, Ministry of Welfare, Resolution No. 12011/68/93-BCC (C) dated Place______________
10th September, 1993 published in the Gazette of India Extraordinary Part-I, Section- Date_______________
1, dated the 13th September, 1993.**
* Please delete the words which are not applicable
(ii) Government of India, Ministry of Welfare, Resolution No. 12011/9/94-BCC, dated Note : The term 'Ordinarily reside(s)' used here will have the same meaning as in Section
19.10.94 published in the Gazette of India Extraordinary Part-I, Section-1, No. 163, 20 of the Representation of the People Act, 1950.
dated 20.10.94. **Officers competent to issue Caste/Tribe certificates :
Shri ................................. and/or his family ordinarily reside/(s) in the ...................................... (i) District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/
District/Division of the ........................................... State. Additional Deputy Commissioner/Deputy Collector/Ist Class Stipendiary Magistrate/
This is also to certify that he/she does not belong to the persons/sections (Creamy Layer) City Magistrate/+Sub-Divisional Magistrate/Taluka Magistrate/Executive Magistrate/
mentioned in Column 3 of the Schedule to the Government of India, Department of Extra Assistant Commissioner.
Personnel and Training O.M. No. 36002/22/93-Estt. (SCT), dated 8.9.1993. +Not below the rank of Ist Class Stipendiary Magistrate.
(ii) Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency
Dated : District Magistrate
Magistrate.
SEAL : Deputy Commissioner etc.
(iii) Revenue Officers not below the rank of Tehsildar.
N.B. : (a) The term 'Ordinarily' used here will have the same meaning as in the Section (iv) Sub-Divisional Officers of the area where the candidate and/or his family normally
20 of the Representation of the People's Act, 1950 reside(s).
(b) Where the certificates are issued by the Gaztted Officers of the Union (v) Administrator/Secretary to Administrator/Development Officer(Lakshadweep).
Government or State Governments they should be in the same form but
countersigned by the District Magistrate or Deputy Commissioner (Certificates FORM OF PHYSICALLY DISABLED CATEGORY
issued by Gazetted Officers and attested by District Magistrate/Deputy I, Dr. __________________________ Regn. No. _________________ examined Shri/
Commissioner are not sufficient). Smt./Kum. ______________ whose particulars are given below and hereby certify that
*Strike out whichever is not applicable. he/she is a permanent physically disabled person of the following category :-
(i) BL-Both legs affected but not arms.
**Officers competent to issue Class/Tribe Certificates.
(ii) BA-Both arms affected (a) Impaired reach
(i) District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/ (b) Weakness of grip
Additional Deputy Commissioner/Deputy Collector/1st Class Stipendiary Magistrate/ (iii) BLA-Both legs and both arms affected
City Magistrate/@Sub-Divisional Magistrate/Taluka Magistrate/Executive (iv) OL-One leg affected (right or left) (a) Impaired reach
Magistrate/ Extra Assistant Commissioner. (b) Weakness of grip
@ (Not below the rank of Ist Class Stipendiary Magistrate) (c) Ataxic
(ii) Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency (v) OA-One arm affected (a) Impaired reach
Magistrate. (b) Weakness of grip
(c) Ataxic
(iii) Revenue Officers not below the rank of Tehsildar.
(vi) BH-Stiff back and hips (Cannot sit or stoop)
(iv) Sub-Divisional Officer of the area where the candidate and his family normally (vii) MW-Muscular weakness and limited physical endurance.
reside(s).
(viii) B-Blind
(v) Administrator/Secretary to Administrator/Development Officer (Lakshadweep). (ix) PB-Partially Blind
(x) PD-Partially Deaf
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE[IN (xi) D-Deaf
ADDITION TO THE COMMUNITY CERTIFICATE(OBC)].
(Delete the category whichever is not applicable)
I................................ son/daughter of Shri ............................... resident of village/town/
city....................... district.......................... state..................... hereby declare that I belong 2. The percentage of disability in his/her case is _____________________
to the .....................community which is recognized as a backward class by the Government 3. Shri/Smt./Kum ............................. meets the following physical requirements for
of India for the purpose of reservation in services as per orders contained in Department discharge of his /her duties :-
of Personnel and Training Office Memorandum No.36102/22/93-Esstt.(SCT) dated 8-9- (i) F-Work performed by manipulating with fingers.
1993. It is also declared that I do not belong to persons/sections(Creamy Layer)mentioned (ii) PP-Work performed by pulling and pushing.
in colum 3 of the Schedule to the above referred Office Memorandum dated 8-9-1993. (iii) L-Work performed by lifting.
(SIGNATURE OF THE CANDIDATE)
(iv) KC-Work performed by kneeling and chrouching.
FULL NAME .........................
(v) B-Work performed by bending.
ADDRESS :
(vi) S-Work performed by sitting.
The form of certificate to be produced by Scheduled Castes and Scheduled (vii) ST-Work performed by standing.
Tribes candidates applying for appointment to posts under the Government of
(viii) W-Work performed by walking.
India
(ix) SE-Work performed by seeing.
This is to certify that Shri/Shrimati/Kumari* ____________________ son/daughter* of (x) H-Work performed by hearing/speaking.
________________ of village/town/* ___________ in District/Division*___________ Shri
(xi) RW-Work performed by reading and writing.
____________________ of the State/Union Territory* ________ belongs to the Caste/
(Delete whichever is not applicable)
Tribe* which is recognized as a Scheduled Caste/Scheduled Tribe* under:-
4. Shri/Smt./Kum. ______________________ does not suffer from disease (communicable
The Constitution(Scheduled Castes) Order, 1950* or otherwise), constitutional weakness or bodily infirmity that may interfere with the efficient
The Constitution(Scheduled Tribes) Order, 1950* discharge of his/her duties as an Officer under the Govt. of India.
The Constitution(Scheduled Castes) (Union Territories) Order, 1951* (i) Name of the Candidate _____________________________
(ii) Father's Name _____________________________________
The Constitution(Scheduled Tribes) (Union Territories) Order, 1951*
(iii) Identification Marks _________________________________
[as amended by the Scheduled Castes and Scheduled Tribes Lists(Modification) Order, (iv) Sex _____________________________________________
1956, the Bombay Reorganization Act, 1960, the Punjab Reorganization Act, 1966, the (v) Age _____________________________________________
State of Himachal Pradesh Act 1970 and the North-Eastern Areas (Reorganization) Act, Signature of Surgeon/Medical Officer
1971 and the Scheduled Castes and Scheduled Tribes Order (Amendment) Act, 1976]. Designation __________________
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956* Signature of Candidate
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order, 1959 as Office Stamp _________________
Address _____________________
amended by the Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 1976*
Note : The disability certificate should be issued by a Govt. Hospital.
The Constitution (Dadra and Nagar Haveli) Scheduled Castes Order, 1962*
FORM OF CERTIFICATE TO BE PRODUCED BY MERITORIOUS SPORTSPERSONS
The Constitution(Dadra and Nagar Haveli) Scheduled Tribes Order, 1962* FOR CLAIMING AGE-RELAXATION FOR APPOINTMENT TO POSTS
The Constitution (Pondicherry) Scheduled Castes Order, 1964* UNDER THE CENTRAL GOVERNMENT
FORM-I
The Constitution (Scheduled Tribes) (Uttar Pradesh ) Order, 1967*
(For representing India in an International
The Constitution (Goa, Daman and Diu) Scheduled Castes Order, 1968* Competition in one of the recognised Games/Sports)
The Constitution (Goa, Daman and Diu) Scheduled Tribes Order, 1968* NATIONAL FEDERATION/NATIONAL ASSOCIATION OF ________________________
Certificate to meritorious sportsmen for employment under the Central Government.
The Constitution (Nagaland) Scheduled Tribes Order, 1970* Certified that Shri/Smt./Kumari ______________________ Son/Wife/Daughter of Shri
The Constitution (Sikkim) Scheduled Castes Order, 1978* _______________ resident of ____________________ (Complete address) represented
the Country in the game/event of _____________________ in ________ competition/
The Constitution (Sikkim) Scheduled Tribes Order, 1978* tournament held at _____________________ from _________ to _______.
2. Shri/Shrimati/Kumari* ______________ and /or his/her* family ordinarily, reside(s) in Cont. on page 54
54 UPSC Employment News 19 February - 4 March 2011
Cont. from page 53 ANNEXURE-A
The position obtained by the individual/team in the above said Competition/Tournament (Letter Head of the Institution/Issuing Authority)
was ________________. Telephone No ………………..
The Certificate is being given on the basis of record available in the office of National Fax No ………………..
Federation/National Association of __________________________ Name of Organisation
Address of the Organisation
Place ___________ Signature ________________ Dated .......................
Date ___________ Name ___________________ EXPERIENCE CERTIFICATE
Designation ______________ 1. This is to certify that Shri/Ms ……………….. S/o,D/o,W/o Shri. ……………….. was/is
Name of the Federation/National an
Association ________________ employee of this Organisation/Department/Ministry and duties performed by him/her
Address __________________ during the period(s) are as under :-
Seal _____________________ Name of From To Total period Nature of Department/
post held dd/mm/yy dd/mm/yy dd/mm/yy appointment - Specialty/
Note : This certificate will be valid only when signed personally by the Secretary, National
Permanent, Regular, Field of
Federation/National Association.
Temporary, Part- experience
FORM-II time, Contract,
(For representing a State in India in a National competition in Guest, Honorary,
one of the recognised Games/Sports) etc
STATE ASSOCIATION OF __________________ IN THE GAME OF ______________" (1) (2) (3) (4) (5) (6)
Certificate to a meritorious sportsman for employment under the Central Government.
Certified that Shri/Smt./Kumari _________________ son/wife/daughter of Shri ______
________________ resident of __________________________ (Complete Address)
__________________ represented the State of ______________ in the game/event of
______________ in the National Competition/Tournament held at ________________
from _________________ to ______________ .
The position obtained by the individual/team in the above said Competition/Tournament
was _________________________. Pay scale Duties performed/experience gained Place of Worked at
The certificate is being given on the basis of record available in the office of the State and last in brief in each post (please give posting supervisory
Association of ___________________________. salary details, if need be, in attached level/middle
Signature _________________ drawn sheet) (In case of Medical posts, please management
Place _____________ Name ___________________ mention field of specialization) level/head of
Date ___________ Designation ______________ branch
Name of the State Association (7) (8) (9) (10)
Address _________________
Seal ____________________
Note : This certificate will be valid only when signed personally by the Secretary to the
State Association.
Certificate to be produced by Serving/Retired/Released Armed Forces Personnel
for availing the age concession for posts filled by direct recruitment by
Union Public Service Commission otherwise than on results of an open
competitive examination 2. It is certified that above facts and figures are true and based on service records
(A) Form of Certificate applicable for released/retired Personnel : available in our organization/Department/Ministry.
It is certified that No. _______________ Rank ____________ Name ______________ Signature
(Name of competent authority)
whose date of birth is ______________ has rendered services from _____ to
Stamp of issuing authority
_____________ in Army/Navy/Air Force. He has not been released :-
(i) by way of dismissal, or ANNEXURE-B
(ii) by way of discharge on account of misconduct or inefficiency, or (Letter Head of the Institution/ Issuing Authority)
Telephone No …………………
(iii) on his own request, but without earning his pension, or
Fax No …………………
(iv) he has not been transferred to the reserve pending such release. Name of Organisation
2. He is covered under the definition of Ex-Servicemen (Re-employment in Central Civil Address of the Organisation
Services and Posts Rules, 1979, as amended from time to time. Dated ........................
Name : (For experience while pursuing DNB/DM/M.Ch. Courses)
Station : Designation of the Competent Authority : This is to certify that Dr. ………………… Son/Daughter/Wife of Shri …………………
Date : Seal : (Registration No. …………………) was a student for Diplomate of National Board(DNB)/
Doctor in Medicine(DM)/Magister Chirurgiae(M.Ch)in ………………… (name of Course)
(B) Form of Certificate applicable for serving Personnel :
in this Hospital/College/Institution with effect from ………………… to ………………….
It is certified that No. ________________ Rank ________________ Name __________ (…………………years course) in the Department of …………………
is serving in the Army/Navy/Air Force from ____________________ 2. He/She was declared successful in DNB/ DM/ M.Ch. in ………………… (Name of
2. He is due for release/retirement on completion of his specific period of assignment on Course) examination vide Notification No. ………………… dated ………………… The
________________ Degree of DNB/DM/M.Ch. in ………………… (Name of Specialty) awarded to Dr.
3. No disciplinary case is pending against him. …………………by this College/University is recognized by the Medical Council of India.
NOTE-I: The experience gained is recognized by the MCl or the Statutory body
Name :
concerned for the system of medicine as valid teaching experience (for teaching medical
Station : Desigation of the Competent Authority: posts only).
Date : Seal : NOTE-II: The medical institution/college from where the experience is/are gained, is/
(C) Certificate for serving ECOs/SSCOs who have already completed their initial are recognized by the concerned medical authority (for medical posts only).
Assignment and are on Extended Assignment : 3. It is certified that above facts and figures are true and based on service records
available in our organization/ Department/Ministry.
It is certified that No. _________________ Rank ____________ Name ____________
Signature
whose date of Birth is ___________________ is serving in the Army/Navy/Air Force from
(Name of competent authority)
____________________.
Stamp of issuing authority
2. He has already completed his initial assignment of five years on _____________ and
ANNEXURE C
is on extended assignment till ________________________.
(Letter Head of the Institution/Issuing Authority)
3. There is no objection to his applying for Civil employment and he will be released on Telephone No ..................
three months notice on selection from the date of receipt of offer of appointment. Fax No ..................
Name : Name of Organisation
Station : Designation of the Comptent Authority : Address of the Organisation
Date : Seal : Dated ..................
(For experience at Bar for Advocates)
Authorities to Issue certificate in respect of Commissioned Officers of the three This is to certify that Shri/Ms …………………(Registration No …………………), S/o, D/o,
Services: W/o Shri…………………has been practicing/practiced as an Advocate dealing with
Army : Military Secretary's Branch, Army Head Quarters, N. Delhi. criminal/civil cases from …………………to ………………… in the CAT/Session Court/
Navy : Directorate of Personnel, Naval Head Quarters, N. Delhi. High Court/Supreme Court at …………………
2. It is certified that above facts and figures are true and based on service records
Air Force : Directorate of Personnel, (Officers) Air Head Quarters, N. Delhi.
available in our organization/Department/Ministry.
Authorities to Issue certificate in respect of JCOs/ORs and equivalent of the Navy
Signature
and Air Force :
(Name of competent authority)
Army : By various Regimental Record Officers. Stamp of issuing authority
Navy B.A.B.S., Bombay
davp 55104/14/0059/1011
Air Force : Air Force Records (NERW), N. Delhi. EN 48/#